Provider Demographics
NPI:1124726179
Name:ALEGENT CREIGHTON HEALTH
Entity type:Organization
Organization Name:ALEGENT CREIGHTON HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:B
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-717-2320
Mailing Address - Street 1:12809 WEST DODGE ROAD
Mailing Address - Street 2:2ND FLOOR, PHARMACY
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154
Mailing Address - Country:US
Mailing Address - Phone:402-717-2320
Mailing Address - Fax:
Practice Address - Street 1:1625 N 205TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68022
Practice Address - Country:US
Practice Address - Phone:402-758-5560
Practice Address - Fax:402-758-5565
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALEGENT CREIGHTON HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-20
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy