Healthcare Provider Details

I. General information

NPI: 1912719014
Provider Name (Legal Business Name): JESSICA PRUCHA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 DEWEY AVE
OMAHA NE
68105-1017
US

IV. Provider business mailing address

14517 NELSONS CREEK DR
OMAHA NE
68116-4123
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-7008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number16478
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: