Provider Demographics
NPI:1811523467
Name:DIDRICHSONS, ANDRIS (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDRIS
Middle Name:
Last Name:DIDRICHSONS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1908
Mailing Address - Country:US
Mailing Address - Phone:402-467-1134
Mailing Address - Fax:
Practice Address - Street 1:1800 E 29TH ST
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-3074
Practice Address - Country:US
Practice Address - Phone:402-826-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist