Provider Demographics
NPI:1235764416
Name:MILES-ZENON, CASSAUNDRA L (RPH)
Entity Type:Individual
Prefix:MS
First Name:CASSAUNDRA
Middle Name:L
Last Name:MILES-ZENON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 N 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-6159
Mailing Address - Country:US
Mailing Address - Phone:402-216-6775
Mailing Address - Fax:
Practice Address - Street 1:8315 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3111
Practice Address - Country:US
Practice Address - Phone:402-393-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-08
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist