Provider Demographics
NPI:1063498178
Name:NYSTROM, KELLY K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:K
Last Name:NYSTROM
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:CREIGHTON UNIVERSITY - PHARMACY PRACTICE DEPARTMEN
Mailing Address - Street 2:2500 CALIFORNIA PLAZA
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68178-0001
Mailing Address - Country:US
Mailing Address - Phone:402-398-5747
Mailing Address - Fax:402-398-5928
Practice Address - Street 1:CREIGHTON UNIVERSITY - PHARMACY PRACTICE DEPARTMEN
Practice Address - Street 2:2500 CALIFORNIA PLAZA
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68178-0001
Practice Address - Country:US
Practice Address - Phone:402-398-5747
Practice Address - Fax:402-398-5928
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE11081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist