Healthcare Provider Details

I. General information

NPI: 1356673040
Provider Name (Legal Business Name): PONCA TRIBE OF NEBRASKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 J ST
OMAHA NE
68107-1643
US

IV. Provider business mailing address

2602 J ST
OMAHA NE
68107-1643
US

V. Phone/Fax

Practice location:
  • Phone: 402-734-5275
  • Fax: 402-734-5708
Mailing address:
  • Phone: 402-734-5275
  • Fax: 402-734-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS M SCHUFELDT
Title or Position: CHEIF PHARMACIST
Credential: PHARM.D.
Phone: 402-734-5275