Organization
ALEGENT CREIGHTON HEALTH
Active
Other names
CHI Health Pharmacy - Immanuel
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE TIESI (SENIOR DIRECTOR OF PHARMACY)
(402) 343-4546
Entity
Organization
Contact information
Practice address
6829 N 72ND ST STE 2160, OMAHA, NE 68122-1724
(402) 572-2300
(402) 572-2308
Mailing address
6829 N 72ND ST STE 2160, OMAHA, NE 68122-1724
(402) 572-2300
(402) 572-2308
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2519
NE
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026500800
—
NE
01
—
2054563
PK
—
01
—
2811532
NABP
NE
05
—
4686
—
IA
Enumeration date
03/09/2007
Last updated
12/18/2024
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