Provider Demographics
NPI:1477547347
Name:CREIGHTON UNIVERSITY
Entity Type:Organization
Organization Name:CREIGHTON UNIVERSITY
Other - Org Name:CREIGHTON UNIVERSITY MEDICAL CENTER CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FOR ADMIN AND FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:402-280-2131
Mailing Address - Street 1:2412 CUMING ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1602
Mailing Address - Country:US
Mailing Address - Phone:402-449-4560
Mailing Address - Fax:402-449-4531
Practice Address - Street 1:2412 CUMING ST STE 201
Practice Address - Street 2:CUMC CLINIC PHARMACY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-1602
Practice Address - Country:US
Practice Address - Phone:402-449-4560
Practice Address - Fax:402-449-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X, 3336C0004X
NE31153336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2053351OtherPK
IA0543116Medicaid
2053351OtherPK
099081Medicare PIN
IA0543116Medicaid
0627910016Medicare NSC