Provider Demographics
NPI:1134250046
Name:ALEGENT CREIGHTON HEALTH
Entity type:Organization
Organization Name:ALEGENT CREIGHTON HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4546
Mailing Address - Street 1:6829 N 72ND ST STE 2160
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1724
Mailing Address - Country:US
Mailing Address - Phone:402-572-2300
Mailing Address - Fax:402-572-2308
Practice Address - Street 1:6829 N 72ND ST STE 2160
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1724
Practice Address - Country:US
Practice Address - Phone:402-572-2300
Practice Address - Fax:402-572-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336I0012X, 3336L0003X
NE25193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026500800Medicaid
NE2811532OtherNABP
2054563OtherPK
IA4686Medicaid
NE10026500800Medicaid