Healthcare Provider Details

I. General information

NPI: 1457636854
Provider Name (Legal Business Name): TAYLOR DOYLE HEGARTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CALIFORNIA PLZ
OMAHA NE
68178-0133
US

IV. Provider business mailing address

1322 N 52ND ST
OMAHA NE
68132-1420
US

V. Phone/Fax

Practice location:
  • Phone: 763-913-2246
  • Fax: 402-280-1148
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7665
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: