Healthcare Provider Details

I. General information

NPI: 1790345239
Provider Name (Legal Business Name): ANDREW LAWRENCE SCHLEISMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12741 Q ST
OMAHA NE
68137-3211
US

IV. Provider business mailing address

20625 E ST
ELKHORN NE
68022-2273
US

V. Phone/Fax

Practice location:
  • Phone: 402-895-3102
  • Fax:
Mailing address:
  • Phone: 712-210-7044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15749
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: