Provider Demographics
NPI:1063700318
Name:HUSTON, JESSICA A (CPHT, BS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:HUSTON
Suffix:
Gender:F
Credentials:CPHT, BS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:LENTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13660 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5233
Mailing Address - Country:US
Mailing Address - Phone:402-965-8800
Mailing Address - Fax:
Practice Address - Street 1:13660 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5233
Practice Address - Country:US
Practice Address - Phone:402-965-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1321183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician