MEDICARE: AMY SUE DOUGLAS 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	11878	NE

General Provider Information

NPI Number	:	1487253431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SUE DOUGLAS RP

Provider Business Mailing Address
First Line	:	8404 N 30TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68112-2270
Country	:	US
Telephone Number	:	402-451-2135
Fax Number	:	402-952-8032

Provider Business Practice Location Address
First Line	:	8404 N 30TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68112-2270
Country	:	US
Telephone Number	:	402-451-2135
Fax Number	:	402-952-8032

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

Provider Enumeration Date	:	10/21/2020
Last Update Date	:	10/21/2020

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Directions to “ AMY SUE DOUGLAS RP” Practice Location

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