Provider Demographics
NPI:1629337217
Name:HAHN, BERTENHAHN CRAIG (RPH)
Entity Type:Individual
Prefix:MR
First Name:BERTENHAHN
Middle Name:CRAIG
Last Name:HAHN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 S 76TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-4617
Mailing Address - Country:US
Mailing Address - Phone:402-730-7487
Mailing Address - Fax:
Practice Address - Street 1:3510 S 76TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-4617
Practice Address - Country:US
Practice Address - Phone:402-730-7487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist