Provider Demographics
NPI:1548343296
Name:WRIGHT, JACK DAVID (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:DAVID
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 DOW DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1736
Mailing Address - Country:US
Mailing Address - Phone:402-294-7358
Mailing Address - Fax:
Practice Address - Street 1:2501 CAPEHART
Practice Address - Street 2:ERHLING BERGQUIST HOSPITAL
Practice Address - City:OFFUTT AFB
Practice Address - State:NE
Practice Address - Zip Code:68113
Practice Address - Country:US
Practice Address - Phone:402-502-2057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist