Provider Demographics
NPI:1902031446
Name:HAUSMANN, PEGGY C (RPH)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:C
Last Name:HAUSMANN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 THALLAS ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-8600
Mailing Address - Country:US
Mailing Address - Phone:712-322-8710
Mailing Address - Fax:
Practice Address - Street 1:2528 THALLAS ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-8600
Practice Address - Country:US
Practice Address - Phone:712-322-8710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
320059Medicare Oscar/Certification