Healthcare Provider Details

I. General information

NPI: 1841323284
Provider Name (Legal Business Name): DOUGLAS COUNTY NEBRASKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 WOOLWORTH AVE
OMAHA NE
68105-1899
US

IV. Provider business mailing address

4102 WOOLWORTH AVE
OMAHA NE
68105-1899
US

V. Phone/Fax

Practice location:
  • Phone: 402-444-7403
  • Fax: 402-444-7729
Mailing address:
  • Phone: 402-444-7403
  • Fax: 402-444-7729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1512
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIN NELSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-444-7041