Betty Jean Ketchmark, PHARMD RP
Individual provider Active NPI Pharmacist · Lavista, NE
NPI 1659080893 · NPPES record last updated Nov 16, 2022
Key facts
- NPI
- 1659080893
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 10348 (NE)
- Practice address
- 8637 S 99 Circle
Lavista, NE 68128-7010 - Phone
- (402) 639-0965
- NPI assigned
- Nov 16, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P7739 | ID | MD | Pharmacist |
| 10348 | NE | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P7739 | ID | |
| Pharmacist | 183500000X | 10348 | NE | Yes |
Addresses
Primary practice location
8637 S 99 Circle
Lavista, NE 68128-7010
Mailing address
8637 S 99 Circle
Lavista, NE 68128-7010
Phone (402) 639-0965
Other names
- Dr. Betty Jean Fibich
Other providers in Lavista, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.