Provider Demographics
NPI:1699264630
Name:RAFTERY, BRANDY
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:RAFTERY
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 1:1800 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-3074
Mailing Address - Country:US
Mailing Address - Phone:402-826-1032
Mailing Address - Fax:402-826-1039
Practice Address - Street 1:1800 E 29TH ST
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-3074
Practice Address - Country:US
Practice Address - Phone:402-826-1032
Practice Address - Fax:402-826-1039
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist