Healthcare Provider Details

I. General information

NPI: 1205490067
Provider Name (Legal Business Name): EMILY SVOBODA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 GRANT ST
OMAHA NE
68111-3863
US

IV. Provider business mailing address

924 N 74TH AVE
OMAHA NE
68114-3114
US

V. Phone/Fax

Practice location:
  • Phone: 402-451-3244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number15636
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: