Provider Demographics
NPI:1801826870
Name:CREUTZ, NORMAN EUGENE (RP)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:EUGENE
Last Name:CREUTZ
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 E BROADWAY ST
Mailing Address - Street 2:BOX F
Mailing Address - City:WAUSA
Mailing Address - State:NE
Mailing Address - Zip Code:68786-1559
Mailing Address - Country:US
Mailing Address - Phone:402-586-2552
Mailing Address - Fax:402-586-2552
Practice Address - Street 1:517 E BROADWAY ST
Practice Address - Street 2:BOX F
Practice Address - City:WAUSA
Practice Address - State:NE
Practice Address - Zip Code:68786-1559
Practice Address - Country:US
Practice Address - Phone:402-586-2552
Practice Address - Fax:402-586-2552
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47052811900Medicaid
NE47052811900Medicaid