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General NPI Number Information
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NPI Number | 1821009069
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Entity Type | Organization
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Legal Business Name | STATE OF NEBRASKA DEPT OF ADMIN SERVICES
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 801 W PROSPECTOR PL
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City | LINCOLN
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State | NE
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Zip | 68522-1970
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Country | US
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Telephone | 402-479-5343
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Fax | 402-479-5438
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Provider Business Mailing Address
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Address Line | 801 W PROSPECTOR PL
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City | LINCOLN
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State | NE
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Zip | 68522-1970
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Country | US
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Telephone | 402-479-5343
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Fax | 402-479-5438
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | LACEY DETERDING
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Credential | PHARMD
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Telephone | 402-479-5343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 2517
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License Number State | NE
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