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
3135 W BROADWAY, SUITE 101, COUNCIL BLUFFS, IA 51501-3359
(712) 242-2070
(712) 242-2077
Mailing address
3135 W BROADWAY, SUITE 101, COUNCIL BLUFFS, IA 51501-3359
(712) 242-2070
(712) 242-2077
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0220546
—
IA
05
—
10026519120
—
NE
01
—
1081
NEBRASKA NON RESIDENT MAIL SERVICE PHARMACY
NE
01
—
1504
IOWA COMMUNITY PHARMACY PERMIT
IA
Enumeration date
04/15/2014
Last updated
10/23/2017
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