MEDICARE: JANET L EXSTROM RP

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	9899	NE

General Provider Information

NPI Number	:	1083710537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET L EXSTROM RP

Provider Business Mailing Address
First Line	:	PO BOX 804
Second Line	:
City	:	HOLDREGE
State	:	NE
Zip	:	68949-0804
Country	:	US
Telephone Number	:	308-995-5414
Fax Number	:	308-995-2051

Provider Business Practice Location Address
First Line	:	414 EAST AVE
Second Line	:
City	:	HOLDREGE
State	:	NE
Zip	:	68949-2215
Country	:	US
Telephone Number	:	308-995-5414
Fax Number	:	308-995-2051

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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Directions to “ JANET L EXSTROM RP” Practice Location

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