Healthcare Provider Details

I. General information

NPI: 1902768658
Provider Name (Legal Business Name): TARA LYNN BUETTNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE
OMAHA NE
68105-1850
US

IV. Provider business mailing address

5104 GROVER ST APT 1
OMAHA NE
68106-3857
US

V. Phone/Fax

Practice location:
  • Phone: 402-346-8800
  • Fax:
Mailing address:
  • Phone: 402-608-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18651
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: