Provider Demographics
NPI:1932485737
Name:SYSEL, STEWART L (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEWART
Middle Name:L
Last Name:SYSEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5038 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3111
Mailing Address - Country:US
Mailing Address - Phone:402-551-6205
Mailing Address - Fax:402-558-1519
Practice Address - Street 1:5038 CENTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3111
Practice Address - Country:US
Practice Address - Phone:402-551-6205
Practice Address - Fax:402-558-1519
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist