Provider Demographics
NPI:1477374551
Name:MCEWIN, SOPHIE (PHARMD)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:MCEWIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:SEALER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8801 S 167TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-4301
Mailing Address - Country:US
Mailing Address - Phone:402-206-1079
Mailing Address - Fax:
Practice Address - Street 1:3540 VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4706
Practice Address - Country:US
Practice Address - Phone:402-483-3885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE175301835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Single Specialty