Healthcare Provider Details

I. General information

NPI: 1902158066
Provider Name (Legal Business Name): JESSICA DOWNES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 SO 30TH STREET SUITE 103
OMAHA NE
68107-1656
US

IV. Provider business mailing address

4920 SO 30TH STREET SUITE 103
OMAHA NE
68107-1656
US

V. Phone/Fax

Practice location:
  • Phone: 402-734-4110
  • Fax: 402-734-3990
Mailing address:
  • Phone: 402-734-4110
  • Fax: 402-734-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15200
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-14998
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14602
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: