Provider Demographics
NPI:1417132457
Name:MOURGIS, JUNE M (BS PHA)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:M
Last Name:MOURGIS
Suffix:
Gender:F
Credentials:BS PHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11725 ARBOR ST STE 115C
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2974
Mailing Address - Country:US
Mailing Address - Phone:402-682-7326
Mailing Address - Fax:402-708-9732
Practice Address - Street 1:11725 ARBOR ST STE 115C
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2974
Practice Address - Country:US
Practice Address - Phone:402-682-7326
Practice Address - Fax:402-708-9732
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10245183500000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No183500000XPharmacy Service ProvidersPharmacist