MEDICARE: DR. IRMA GAIL DEYLE 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	8990	NE

General Provider Information

NPI Number	:	1154315141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRMA GAIL DEYLE RP

Provider Business Mailing Address
First Line	:	6241 S 170TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-3051
Country	:	US
Telephone Number	:	402-894-1377
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 N 30TH ST
Second Line	:	SUITE 2807
City	:	OMAHA
State	:	NE
Zip	:	68131-2137
Country	:	US
Telephone Number	:	402-449-4560
Fax Number	:	402-449-4531

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. IRMA GAIL DEYLE RP” Practice Location

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