Provider Demographics
NPI:1497023634
Name:SECREST, DAVID TODD (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TODD
Last Name:SECREST
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 N 142 ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5039
Mailing Address - Country:US
Mailing Address - Phone:402-898-0282
Mailing Address - Fax:
Practice Address - Street 1:4404 N 142ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5039
Practice Address - Country:US
Practice Address - Phone:402-898-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist