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General NPI Number Information
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NPI Number | 1659743920
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Entity Type | Organization
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Legal Business Name | CHARLES DREW HEALTH CENTER
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 2915 GRANT ST
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City | OMAHA
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State | NE
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Zip | 68111-3863
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Country | US
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Telephone | 402-810-9806
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Fax | 402-453-1970
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Provider Business Mailing Address
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Address Line | 2915 GRANT ST
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City | OMAHA
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State | NE
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Zip | 68111-3863
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Country | US
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Telephone | 402-810-9806
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Fax | 402-453-1970
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICIER
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Name | MISS TARSHA DENISE JACKSON
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Credential |
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Telephone | 402-457-1215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 2283
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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