Provider Demographics
NPI:1851666234
Name:EBERT, FRED H
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:H
Last Name:EBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 W DODGE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2382
Mailing Address - Country:US
Mailing Address - Phone:402-952-3249
Mailing Address - Fax:402-952-3246
Practice Address - Street 1:12300 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2382
Practice Address - Country:US
Practice Address - Phone:402-952-3249
Practice Address - Fax:402-952-3246
Is Sole Proprietor?:No
Enumeration Date:2012-03-18
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8670183500000X
IA14861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE8670OtherSTATE OF NEBRASKA BOARD OF PHARMACY LICENCE NUMBER