Provider Demographics
NPI:1912274010
Name:THOMSEN, MARY K (RP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:THOMSEN
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-1449
Mailing Address - Country:US
Mailing Address - Phone:402-558-6065
Mailing Address - Fax:
Practice Address - Street 1:7151 CASS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2652
Practice Address - Country:US
Practice Address - Phone:402-558-6065
Practice Address - Fax:402-558-8770
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8078183500000X
IA13808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist