Provider Demographics
NPI:1124030887
Name:EDET, ESSIEN (RPH)
Entity Type:Individual
Prefix:
First Name:ESSIEN
Middle Name:
Last Name:EDET
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8807 F ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1506
Mailing Address - Country:US
Mailing Address - Phone:402-339-4036
Mailing Address - Fax:402-339-4081
Practice Address - Street 1:8807 F ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1506
Practice Address - Country:US
Practice Address - Phone:402-339-4036
Practice Address - Fax:402-339-4081
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist