=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831475110
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA J WESSON PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2011
-----------------------------------------------------
Last Update Date | 10/31/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11343 S 96TH ST
-----------------------------------------------------
City | PAPILLION
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68046-4280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-408-0761
-----------------------------------------------------
Fax | 402-408-0767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7607 SUSAN AVE
-----------------------------------------------------
City | LA VISTA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68128-2553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-639-7511
-----------------------------------------------------
Fax | 402-408-0767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 9971
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------