Provider Demographics
NPI:1871612556
Name:KASSEBAUM, AARON R (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:R
Last Name:KASSEBAUM
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 1:3278 PRAIRIEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-4631
Mailing Address - Country:US
Mailing Address - Phone:402-477-5099
Mailing Address - Fax:
Practice Address - Street 1:5020 N 27TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1196
Practice Address - Country:US
Practice Address - Phone:402-477-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist