Provider Demographics
NPI:1952818338
Name:ANDERSEN, JOHN TODD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TODD
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16889 OAKMONT DR APT 20
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1834
Mailing Address - Country:US
Mailing Address - Phone:402-203-3392
Mailing Address - Fax:402-289-9278
Practice Address - Street 1:16960 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2237
Practice Address - Country:US
Practice Address - Phone:402-289-9276
Practice Address - Fax:402-289-9278
Is Sole Proprietor?:No
Enumeration Date:2018-01-07
Last Update Date:2018-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist