Provider Demographics
NPI:1033738141
Name:CALDERON, ROCIO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROCIO
Middle Name:
Last Name:CALDERON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20235 GLENDALE AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-4575
Mailing Address - Country:US
Mailing Address - Phone:563-676-6711
Mailing Address - Fax:
Practice Address - Street 1:4840 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-3111
Practice Address - Country:US
Practice Address - Phone:402-558-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22992183500000X
NE15523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE15523OtherNE LICENSE