Provider Demographics
NPI:1679174445
Name:CUEVAS, CARLA JUDITH (PHARM D)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JUDITH
Last Name:CUEVAS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-1122
Mailing Address - Country:US
Mailing Address - Phone:402-249-1507
Mailing Address - Fax:
Practice Address - Street 1:5150 CENTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3122
Practice Address - Country:US
Practice Address - Phone:402-553-4143
Practice Address - Fax:402-553-7569
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist