Provider Demographics
NPI:1043806813
Name:HORAN, ADAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:HORAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13831 CHALCO VALLEY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-6101
Mailing Address - Country:US
Mailing Address - Phone:402-592-5244
Mailing Address - Fax:
Practice Address - Street 1:13831 CHALCO VALLEY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-6101
Practice Address - Country:US
Practice Address - Phone:402-592-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE13722OtherNEBRASKA PHARMACY LICENSE