Provider Demographics
NPI:1477902245
Name:HUMPHREY, DEBRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10311 N 150TH ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NE
Mailing Address - Zip Code:68462-1608
Mailing Address - Country:US
Mailing Address - Phone:402-440-1403
Mailing Address - Fax:
Practice Address - Street 1:10311 N 150TH ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NE
Practice Address - Zip Code:68462-1608
Practice Address - Country:US
Practice Address - Phone:402-440-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-12
Last Update Date:2016-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist