Provider Demographics
NPI:1134405749
Name:KRIENERT, STACI KARIN (PHARMD)
Entity type:Individual
Prefix:MS
First Name:STACI
Middle Name:KARIN
Last Name:KRIENERT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6636 N 73RD PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1803
Mailing Address - Country:US
Mailing Address - Phone:402-573-2221
Mailing Address - Fax:402-573-2231
Practice Address - Street 1:6636 N 73RD PLZ
Practice Address - Street 2:TARGET PHARMACY T2010
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1803
Practice Address - Country:US
Practice Address - Phone:402-573-2221
Practice Address - Fax:402-573-2231
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist