=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356960165
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TONY ZHENG
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2020
-----------------------------------------------------
Last Update Date | 04/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1710 W 2ND ST
-----------------------------------------------------
City | GRAND ISLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68803-5409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-384-4089
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7405 S 102ND ST
-----------------------------------------------------
City | LA VISTA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68128-6711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-690-2928
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 16185
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------