Provider Demographics
NPI:1528063971
Name:CROMER, KELLY OLSSON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:OLSSON
Last Name:CROMER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15206 GROVER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5447
Mailing Address - Country:US
Mailing Address - Phone:402-359-1004
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 250
Practice Address - Street 2:
Practice Address - City:MACY
Practice Address - State:NE
Practice Address - Zip Code:68039-0250
Practice Address - Country:US
Practice Address - Phone:402-837-5381
Practice Address - Fax:402-837-4358
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2017-09-20
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2017-09-20
Provider Licenses
StateLicense IDTaxonomies
NE11831183500000X
OK13101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist