MEDICARE: LISA MARIE BEISTER

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	183700000X	Pharmacy Technician	6515	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6515	OTHER	NE	LICENSE NUMBER

General Provider Information

NPI Number	:	1447825492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE BEISTER

Provider Business Mailing Address
First Line	:	18692 BORMAN ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-4171
Country	:	US
Telephone Number	:	402-682-2722
Fax Number	:

Provider Business Practice Location Address
First Line	:	18692 BORMAN ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-4171
Country	:	US
Telephone Number	:	402-682-2722
Fax Number	:

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

Provider Enumeration Date	:	05/22/2021
Last Update Date	:	05/22/2021

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Directions to “ LISA MARIE BEISTER ” Practice Location

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