Healthcare Provider Details

I. General information

NPI: 1396838124
Provider Name (Legal Business Name): SUSAN LEE ALLEN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN LEE LINDQUIST

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 S 152ND ST
OMAHA NE
68138-3930
US

IV. Provider business mailing address

10004 S 152ND ST
OMAHA NE
68138-3930
US

V. Phone/Fax

Practice location:
  • Phone: 402-896-7952
  • Fax: 402-896-3774
Mailing address:
  • Phone: 402-896-7952
  • Fax: 402-896-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10367
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16455
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS016566
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.018511
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13985
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number32994
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202212862
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-16343
License Number StateKS
# 9
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0013981
License Number StateOR
# 10
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD13077
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: