Provider Demographics
NPI:1154910941
Name:FANKHAUSER, MINDY
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:FANKHAUSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 J ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NE
Mailing Address - Zip Code:68305-2602
Mailing Address - Country:US
Mailing Address - Phone:402-274-4186
Mailing Address - Fax:402-274-4222
Practice Address - Street 1:2220 J ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NE
Practice Address - Zip Code:68305-2602
Practice Address - Country:US
Practice Address - Phone:402-274-4186
Practice Address - Fax:402-274-4222
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist