Healthcare Provider Details

I. General information

NPI: 1063525970
Provider Name (Legal Business Name): LEROY JOHN DINSLAGE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 W HIGHWAY 34 SUITE #1
SEWARD NE
68434-2338
US

IV. Provider business mailing address

740 E PINEWOOD AVE
SEWARD NE
68434-1132
US

V. Phone/Fax

Practice location:
  • Phone: 402-643-2918
  • Fax: 402-643-6956
Mailing address:
  • Phone: 402-643-2507
  • Fax: 402-643-6956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9060
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: