Provider Demographics
NPI:1396805628
Name:HUTFLESS, MARY ANN (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:HUTFLESS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:KOCHANOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3440 S 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3829
Mailing Address - Country:US
Mailing Address - Phone:402-556-3000
Mailing Address - Fax:402-991-7115
Practice Address - Street 1:3440 S 50TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3829
Practice Address - Country:US
Practice Address - Phone:402-556-3000
Practice Address - Fax:402-991-7115
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE8979OtherREGISTERED PHARMACIST