Provider Demographics
NPI:1295005064
Name:MCCONAUGHY, MARTIN LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:LEE
Last Name:MCCONAUGHY
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 1:1306 N 148TH PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1118
Mailing Address - Country:US
Mailing Address - Phone:402-493-2933
Mailing Address - Fax:
Practice Address - Street 1:15525 SPAULDING PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-6211
Practice Address - Country:US
Practice Address - Phone:402-408-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist