Healthcare Provider Details

I. General information

NPI: 1619222825
Provider Name (Legal Business Name): SARA JO WURDEMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 N WASHINGTON ST T-0532
PAPILLION NE
68046-3910
US

IV. Provider business mailing address

718 N WASHINGTON ST T-0532
PAPILLION NE
68046-3910
US

V. Phone/Fax

Practice location:
  • Phone: 402-597-9499
  • Fax:
Mailing address:
  • Phone: 402-597-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13963
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: