Provider Demographics
NPI:1548882210
Name:NEIHARDT, DEREK JOHN (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JOHN
Last Name:NEIHARDT
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 S COTNER BLVD STE 30
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4924
Mailing Address - Country:US
Mailing Address - Phone:402-488-1184
Mailing Address - Fax:402-488-1187
Practice Address - Street 1:1265 S COTNER BLVD STE 30
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4924
Practice Address - Country:US
Practice Address - Phone:402-488-1184
Practice Address - Fax:402-488-1187
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist