Provider Demographics
NPI:1326648304
Name:ALTWINE, DEBORAH LOU (PHAMD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LOU
Last Name:ALTWINE
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5300
Mailing Address - Country:US
Mailing Address - Phone:402-371-0610
Mailing Address - Fax:402-844-3157
Practice Address - Street 1:120 E NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5300
Practice Address - Country:US
Practice Address - Phone:402-371-0610
Practice Address - Fax:402-844-3157
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist