Healthcare Provider Details

I. General information

NPI: 1871401166
Provider Name (Legal Business Name): ELISHA MCLAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

11641 QUEENS DR
OMAHA NE
68164-2042
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-6779
  • Fax:
Mailing address:
  • Phone: 603-843-7901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18766
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: