MEDICARE: DR. PHILLIP JAMES VUCHETICH PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11414	NE

General Provider Information

NPI Number	:	1063406882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP JAMES VUCHETICH PHARM.D.

Provider Business Mailing Address
First Line	:	1726 BOWIE DR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-1617
Country	:	US
Telephone Number	:	402-250-1967
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 MERCY RD
Second Line	:	BERGAN MERCY MEDICAL CENTER
City	:	OMAHA
State	:	NE
Zip	:	68124-2319
Country	:	US
Telephone Number	:	402-398-6167
Fax Number	:	402-398-5744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/08/2007

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