Provider Demographics
NPI:1447257605
Name:KIRKEGAARD, SCOTT A (PHARMD, BCPP)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:KIRKEGAARD
Suffix:
Gender:M
Credentials:PHARMD, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6940 S MARIAN RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-7557
Mailing Address - Country:US
Mailing Address - Phone:402-461-3392
Mailing Address - Fax:402-462-4605
Practice Address - Street 1:405 E 14TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3204
Practice Address - Country:US
Practice Address - Phone:402-462-4600
Practice Address - Fax:402-462-4605
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE106131835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric