Provider Demographics
NPI:1104454305
Name:MATTHEWS, ADRIANE KAY (PHARMD)
Entity type:Individual
Prefix:
First Name:ADRIANE
Middle Name:KAY
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 MERCY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2339
Mailing Address - Country:US
Mailing Address - Phone:402-398-5503
Mailing Address - Fax:402-398-5506
Practice Address - Street 1:7710 MERCY RD STE 102
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2339
Practice Address - Country:US
Practice Address - Phone:402-398-5503
Practice Address - Fax:402-398-5506
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist