Provider Demographics
NPI:1568730083
Name:MERTEN, LUKE ALLEN (RP)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:ALLEN
Last Name:MERTEN
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12943 ELLISON AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-1294
Mailing Address - Country:US
Mailing Address - Phone:402-341-5949
Mailing Address - Fax:
Practice Address - Street 1:2605 S 171ST ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2389
Practice Address - Country:US
Practice Address - Phone:402-697-9393
Practice Address - Fax:402-697-0487
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11762183500000X
IA19756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist