MEDICARE: JAMES POLK

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	10552	NE

General Provider Information

NPI Number	:	1457120388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES POLK

Provider Business Mailing Address
First Line	:	5460 S 56TH ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-1879
Country	:	US
Telephone Number	:	402-423-0870
Fax Number	:

Provider Business Practice Location Address
First Line	:	5460 S 56TH ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68516-1879
Country	:	US
Telephone Number	:	402-423-0870
Fax Number	:

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

Provider Enumeration Date	:	12/20/2023
Last Update Date	:	12/20/2023

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Directions to “ JAMES POLK ” Practice Location

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