Provider Demographics
NPI:1548843832
Name:FELTNER, MARTY JOSEPH (PHARMD)
Entity type:Individual
Prefix:
First Name:MARTY
Middle Name:JOSEPH
Last Name:FELTNER
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 1:5501 ALVO RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68514-3206
Mailing Address - Country:US
Mailing Address - Phone:888-486-4404
Mailing Address - Fax:
Practice Address - Street 1:5501 ALVO RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68514-3206
Practice Address - Country:US
Practice Address - Phone:888-486-4404
Practice Address - Fax:833-777-0235
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE11589OtherNEBRASKA PHARMACY LICENSE NUMBER