Healthcare Provider Details

I. General information

NPI: 1386214518
Provider Name (Legal Business Name): JARED MATYA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988149 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8149
US

IV. Provider business mailing address

988149 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8149
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-4000
  • Fax:
Mailing address:
  • Phone: 402-559-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number15311
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: