Active NPI
Amanda Russell
- Pharmacist
- La Vista, NE
National Provider Identifier
1710254388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12408
- Practice address
- 8380 Harrison St
La Vista, NE 68128-2918 - Phone
- (402) 592-7990
- Fax
- (402) 592-7377
- NPI assigned
- Nov 25, 2011
- Last updated
- Nov 25, 2011
- 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 | 12408 | NE | Primary |
Addresses
Primary practice location
8380 Harrison St
La Vista, NE 68128-2918
Mailing address
8380 Harrison St
La Vista, NE 68128-2918
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 |
|---|---|---|---|
| 12408 | NE | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322179200000",
"number": "1710254388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8380 HARRISON ST",
"city": "LA VISTA",
"state": "NE",
"postal_code": "681282918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8380 HARRISON ST",
"city": "LA VISTA",
"state": "NE",
"postal_code": "681282918",
"telephone_number": "402-592-7990",
"fax_number": "402-592-7377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "AMANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-25",
"last_updated": "2011-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NE",
"license": "12408",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Vista, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.