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General NPI Number Information
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NPI Number | 1225318819
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Entity Type | Individual
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Provider Name | MEGAN RAE RUSTAD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 2201 N BROADWELL AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-2153
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Country | US
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Telephone | 308-382-3660
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 COLLEGE ST APT 105
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City | GRAND ISLAND
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State | NE
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Zip | 68803-1727
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Country | US
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Telephone | 641-420-6380
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21498
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License Number State | IA
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