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Organization

ALEGENT CREIGHTON HEALTH

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MIKE TIESI (SENIOR DIRECTOR OF PHARMACY)
(402) 343-4546
Entity
Organization

Contact information

Practice address
3308 SAMSON WAY STE 106A, BELLEVUE, NE 68123-3235
(402) 291-5076
(402) 293-9464
Mailing address
3308 SAMSON WAY STE 106A, BELLEVUE, NE 68123-3235
(402) 291-5076
(402) 293-9464

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
3336C0003X
Community/Retail Pharmacy
Primary
2807
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0204528
IA
05
10026519106
NE
01
2807
NEBRASKA COMMUNITY PHARMACY PERMIT
NE
01
4704
LICENSE
IA
Enumeration date
10/05/2006
Last updated
10/23/2017
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