Individual
SUSAN M MENDENHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3003 N 108TH ST, OMAHA, NE 68164-3711
(402) 493-3952
(402) 493-8609
Mailing address
5323 WESTERN AVE, OMAHA, NE 68132-2156
(402) 734-9842
(402) 493-8609
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10010
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10010
STATE LICENSE
NE
Enumeration date
01/05/2007
Last updated
07/08/2007
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