Provider Demographics
NPI:1538649215
Name:SUDETA, AMBER (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:SUDETA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:KRISTINE
Other - Last Name:SUDETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMBER SEIER
Mailing Address - Street 1:13130 L ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1866
Mailing Address - Country:US
Mailing Address - Phone:402-334-3497
Mailing Address - Fax:
Practice Address - Street 1:13130 L ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1866
Practice Address - Country:US
Practice Address - Phone:402-334-3497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist