MEDICARE: GERARDO MONTOYA JR. PHARMD

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	16282	NE

General Provider Information

NPI Number	:	1649995911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARDO MONTOYA JR. PHARMD

Provider Business Mailing Address
First Line	:	7614 JOSEPHINE ST
Second Line	:
City	:	LA VISTA
State	:	NE
Zip	:	68128-2257
Country	:	US
Telephone Number	:	402-830-5973
Fax Number	:

Provider Business Practice Location Address
First Line	:	2307 23RD ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-3303
Country	:	US
Telephone Number	:	402-564-5105
Fax Number	:	402-564-5145

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

Provider Enumeration Date	:	10/07/2022
Last Update Date	:	10/07/2022

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