PONCA TRIBE OF NEBRASKA NPI 1760778385

NPI Information

PONCA TRIBE OF NEBRASKA is an indian health service tribal urban indian health i t u pharmacy in Omaha, NE. The provider is an Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. PONCA TRIBE OF NEBRASKA NPI is 1760778385. The provider is registered as an organization entity type.
The provider Is Doing Business As Fred Leroy Health And Wellness Center Pharmacy.

The provider's business location address is:

2602 J ST
FRED LEROY HEALTH AND WELLNESS CENTER PHARMACY
OMAHA, NE
ZIP 68107-643
Phone: (402) 734-5275
Fax: (402) 733-3487

The provider's authorized official is Donald Lee .
The authorized official title is Chief Executive Officer and has the following contact phone number (402) 734-5275.

The enumeration date for this NPI number is 6/22/2011 and was last updated on 6/22/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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