Healthcare Provider Details

I. General information

NPI: 1982990685
Provider Name (Legal Business Name): TERI JEAN CARSTENS PHARMD, B.A, R.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS TERI JEAN STICKEN

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14460 W MAPLE RD
OMAHA NE
68116-5163
US

IV. Provider business mailing address

14460 W MAPLE RD
OMAHA NE
68116-5163
US

V. Phone/Fax

Practice location:
  • Phone: 402-493-0443
  • Fax: 402-493-0470
Mailing address:
  • Phone: 402-493-0443
  • Fax: 402-493-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10702
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: