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
16101 EVANS ST., SUITE #101, OMAHA, NE 68116-2020
(402) 717-9770
(402) 717-0197
Mailing address
16101 EVANS STREET, SUITE 101, OMAHA, NE 68116-2020
(402) 717-9770
(402) 717-0197
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NE
3336C0003X
Community/Retail Pharmacy
Primary
—
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026519111
—
NE
01
—
595
NEBRASKA COMMUNITY PHARMACY PERMIT
NE
Enumeration date
10/24/2014
Last updated
10/23/2017
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