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General NPI Number Information
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NPI Number | 1932763067
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Entity Type | Individual
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Provider Name | JENNIFER POOTS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 04/24/2019
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Provider Practice Location Address
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Address Line | 6901 S 84TH ST
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City | LA VISTA
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State | NE
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Zip | 68128-2127
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Country | US
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Telephone | 402-339-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 8815 S 164TH ST
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City | OMAHA
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State | NE
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Zip | 68136-1361
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Country | US
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Telephone |
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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 | 23436
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16154
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License Number State | NE
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