Organization
ALEGENT CREIGHTON HEALTH
Active
Other names
CHI Health Pharmacy-Lakeside
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW HAZEN (DIRECTOR)
(402) 343-4546
Entity
Organization
Contact information
Practice address
16909 LAKESIDE HILLS CT, STE 107, OMAHA, NE 68130-4664
(402) 758-5006
(402) 758-5094
Mailing address
16909 LAKESIDE HILLS CT, STE 107, OMAHA, NE 68130-4664
(402) 758-5006
(402) 758-5094
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2661
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026519109
—
NE
01
—
2814879
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/07/2006
Last updated
04/27/2017
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