Individual
KELLI WYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
13105 BIRCH DR, OMAHA, NE 68164-5222
(402) 686-2058
(402) 686-2059
Mailing address
13105 BIRCH DR, OMAHA, NE 68164-5222
(402) 686-2058
(402) 686-2059
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12505
NE
183500000X
Pharmacist
21211
IA
Other
Enumeration date
02/28/2014
Last updated
02/28/2014
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