Healthcare Provider Details

I. General information

NPI: 1679054308
Provider Name (Legal Business Name): DYLAN TYLER SHERRILL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2923 LEAVENWORTH ST
OMAHA NE
68105-2739
US

IV. Provider business mailing address

2923 LEAVENWORTH ST
OMAHA NE
68105-2739
US

V. Phone/Fax

Practice location:
  • Phone: 402-342-6547
  • Fax: 402-341-5207
Mailing address:
  • Phone: 402-342-6547
  • Fax: 402-341-5207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23218
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15796
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: