Organization
ALEGENT CREIGHTON HEALTH
Active
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
16909 LAKESIDE HILLS CT STE 107, OMAHA, NE 68130-4661
(402) 758-5006
(402) 758-5094
Mailing address
16909 LAKESIDE HILLS CT STE 107, OMAHA, NE 68130-4661
(402) 758-5006
(402) 758-5094
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2288
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026519109
—
NE
01
—
2661
NEBRASKA COMMUNITY PHARMACY PERMIT
NE
Enumeration date
10/05/2006
Last updated
10/23/2017
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