Healthcare Provider Details

I. General information

NPI: 1386571669
Provider Name (Legal Business Name): MARIUS DONGMO SOBEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17370 LAKESIDE HILLS PLZ
OMAHA NE
68130-2352
US

IV. Provider business mailing address

17370 LAKESIDE HILLS PLZ
OMAHA NE
68130-2352
US

V. Phone/Fax

Practice location:
  • Phone: 402-333-5351
  • Fax: 402-333-5499
Mailing address:
  • Phone: 402-333-5351
  • Fax: 402-333-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17906
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: