Provider Demographics
NPI:1073027637
Name:CHUDOMELKA, JOSEPH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:CHUDOMELKA
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 1:111 S 186TH PLZ APT 202
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-5401
Mailing Address - Country:US
Mailing Address - Phone:402-730-6438
Mailing Address - Fax:
Practice Address - Street 1:3701 N 132ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-1849
Practice Address - Country:US
Practice Address - Phone:402-431-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-18
Last Update Date:2017-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist