Provider Demographics
NPI:1629244108
Name:HATCLIFF, JOHANNA L (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:L
Last Name:HATCLIFF
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14882 GILES RD
Mailing Address - Street 2:APT 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-3148
Mailing Address - Country:US
Mailing Address - Phone:402-489-3802
Mailing Address - Fax:402-489-7860
Practice Address - Street 1:14882 GILES RD
Practice Address - Street 2:APT 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-3148
Practice Address - Country:US
Practice Address - Phone:402-489-3802
Practice Address - Fax:402-489-7860
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist