Provider Demographics
NPI:1427324763
Name:KRAMOLISCH, MATTHEW L (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:L
Last Name:KRAMOLISCH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13660 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5233
Mailing Address - Country:US
Mailing Address - Phone:402-965-8800
Mailing Address - Fax:402-498-5706
Practice Address - Street 1:13660 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5233
Practice Address - Country:US
Practice Address - Phone:402-965-8800
Practice Address - Fax:402-498-5706
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist