Provider Demographics
NPI:1245012756
Name:WALDRON, MICHAEL LLOYD (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LLOYD
Last Name:WALDRON
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 1:7310 S 34TH CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5779
Mailing Address - Country:US
Mailing Address - Phone:402-875-3124
Mailing Address - Fax:
Practice Address - Street 1:7310 S 34TH CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5779
Practice Address - Country:US
Practice Address - Phone:402-875-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist