Active NPI
Miranda Staab
- Pharmacist
- Omaha, NE
National Provider Identifier
1558013409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 16876
- Practice address
- 7500 Mercy Rd
Omaha, NE 68124-2319 - Phone
- (402) 717-1165
- NPI assigned
- Jan 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 16876 | NE | Primary |
Addresses
Primary practice location
7500 Mercy Rd
Omaha, NE 68124-2319
Mailing address
130 S 184TH CT Apt 104
Elkhorn, NE 68022-5779
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16876 | NE | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642723200000",
"number": "1558013409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 S 184TH CT APT 104",
"city": "ELKHORN",
"state": "NE",
"postal_code": "680225779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7500 MERCY RD",
"city": "OMAHA",
"state": "NE",
"postal_code": "681242319",
"telephone_number": "402-717-1165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAAB",
"first_name": "MIRANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-21",
"last_updated": "2022-01-21",
"certification_date": "2022-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pharmacist",
"state": "NE",
"license": "16876",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.