Provider Demographics
NPI:1326334046
Name:MILTNER, LEO EDWARD JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:EDWARD
Last Name:MILTNER
Suffix:JR
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 1:7200 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3673
Mailing Address - Country:US
Mailing Address - Phone:402-390-8881
Mailing Address - Fax:402-390-8891
Practice Address - Street 1:7200 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3673
Practice Address - Country:US
Practice Address - Phone:402-390-8881
Practice Address - Fax:402-390-8891
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist