Healthcare Provider Details

I. General information

NPI: 1972983328
Provider Name (Legal Business Name): MALLORY MAUREEN RABER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17810 W CENTER RD
OMAHA NE
68130-2308
US

IV. Provider business mailing address

17810 W CENTER RD
OMAHA NE
68130-2308
US

V. Phone/Fax

Practice location:
  • Phone: 402-697-4876
  • Fax:
Mailing address:
  • Phone: 402-697-4876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13212
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: