Provider Demographics
NPI:1578103644
Name:SUCK, NATHAN L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:L
Last Name:SUCK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 SOUTH 61ST STREET
Mailing Address - Street 2:RPM
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106
Mailing Address - Country:US
Mailing Address - Phone:308-218-1527
Mailing Address - Fax:
Practice Address - Street 1:2115 S 61ST ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2129
Practice Address - Country:US
Practice Address - Phone:308-218-1527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE16494OtherPHARMACIST LICENSE NUMBER