Provider Demographics
NPI:1174890370
Name:ARCHER, ELDAN A (RPH)
Entity type:Individual
Prefix:MR
First Name:ELDAN
Middle Name:A
Last Name:ARCHER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9512 S 71ST PLZ
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-2152
Mailing Address - Country:US
Mailing Address - Phone:402-408-1086
Mailing Address - Fax:402-408-1092
Practice Address - Street 1:9512 S 71ST PLZ
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68133-2152
Practice Address - Country:US
Practice Address - Phone:402-408-1086
Practice Address - Fax:402-408-1092
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE07689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist