Provider Demographics
NPI:1104523778
Name:FANKHAUSER, CHRISTOPHER EDWARD (RPH,PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:EDWARD
Last Name:FANKHAUSER
Suffix:
Gender:M
Credentials:RPH,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20250 JENNY LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:NE
Mailing Address - Zip Code:68347-1783
Mailing Address - Country:US
Mailing Address - Phone:402-432-3154
Mailing Address - Fax:
Practice Address - Street 1:8300 NORTHERN LIGHTS DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-3705
Practice Address - Country:US
Practice Address - Phone:402-464-8302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11221183500000X
IA16903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist