Healthcare Provider Details

I. General information

NPI: 1962779785
Provider Name (Legal Business Name): MIKAYLA M CARLSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981090 NEBRASKA MEDICAL CTR
OMAHA NE
68198-1090
US

IV. Provider business mailing address

981090 NEBRASKA MEDICAL CTR
OMAHA NE
68198-1090
US

V. Phone/Fax

Practice location:
  • Phone: 800-922-0000
  • Fax:
Mailing address:
  • Phone: 800-922-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11876
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: