MEDICARE: EMMANUEL S KUVETAKIS

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	14912	NE

General Provider Information

NPI Number	:	1639785256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL S KUVETAKIS

Provider Business Mailing Address
First Line	:	2929 N 60TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-3414
Country	:	US
Telephone Number	:	402-551-6151
Fax Number	:	402-556-6389

Provider Business Practice Location Address
First Line	:	2929 N 60TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-3414
Country	:	US
Telephone Number	:	402-551-6151
Fax Number	:	402-556-6389

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

Provider Enumeration Date	:	09/18/2020
Last Update Date	:	09/18/2020

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Directions to “ EMMANUEL S KUVETAKIS ” Practice Location

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