Provider Demographics
NPI:1578682043
Name:NIEDBALSKI, SHANNA MICHAELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:MICHAELA
Last Name:NIEDBALSKI
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 1:2653 PRAIRIE PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-2440
Mailing Address - Country:US
Mailing Address - Phone:402-606-4062
Mailing Address - Fax:
Practice Address - Street 1:3010 23RD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3122
Practice Address - Country:US
Practice Address - Phone:402-562-7668
Practice Address - Fax:402-563-0915
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist