Healthcare Provider Details

I. General information

NPI: 1982488219
Provider Name (Legal Business Name): CAPWN REPRODUCTIVE HEALTH PROGRAM DELEGATED DISPENSING PERMIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 CRESCENT DR
GERING NE
69341-1712
US

IV. Provider business mailing address

975 CRESCENT DR
GERING NE
69341-1712
US

V. Phone/Fax

Practice location:
  • Phone: 308-632-2770
  • Fax: 308-633-2650
Mailing address:
  • Phone: 308-632-2770
  • Fax: 308-633-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL JAMES BUNDRICK
Title or Position: DELEGATING PHARMACIST
Credential: PHARMD
Phone: 308-632-2770