Provider Demographics
NPI:1861031437
Name:WESTON, NATHAN WAYNE (PHARM D)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:WAYNE
Last Name:WESTON
Suffix:
Gender:M
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 1:6706 S 188TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-4128
Mailing Address - Country:US
Mailing Address - Phone:402-709-7720
Mailing Address - Fax:
Practice Address - Street 1:409 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1826
Practice Address - Country:US
Practice Address - Phone:712-527-4006
Practice Address - Fax:712-527-4113
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist