Individual
MALLORY SANSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
255 N MAIN ST, AINSWORTH, NE 69210-1300
(402) 387-1403
Mailing address
251 N MERTEN ST, AINSWORTH, NE 69210-1564
(785) 760-7046
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16581
NE
Other
Enumeration date
08/15/2024
Last updated
08/15/2024
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