Provider Demographics
NPI:1841567815
Name:VANA, KELLY JO (PHARM D, RPH)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JO
Last Name:VANA
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 S 36TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68147-1231
Mailing Address - Country:US
Mailing Address - Phone:402-734-7592
Mailing Address - Fax:
Practice Address - Street 1:6905 S 36TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68147-1231
Practice Address - Country:US
Practice Address - Phone:402-734-7592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE123341835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy