Provider Demographics
NPI:1548474513
Name:MORAGUES, DONNA (RP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MORAGUES
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 S 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2413
Mailing Address - Country:US
Mailing Address - Phone:402-391-2246
Mailing Address - Fax:402-554-0214
Practice Address - Street 1:4610 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-3234
Practice Address - Country:US
Practice Address - Phone:402-554-1040
Practice Address - Fax:402-554-0124
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist