Healthcare Provider Details

I. General information

NPI: 1558426981
Provider Name (Legal Business Name): PONIDAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 HOWELL ST
OXFORD NE
68967-6754
US

IV. Provider business mailing address

PO BOX 416
OXFORD NE
68967-0416
US

V. Phone/Fax

Practice location:
  • Phone: 308-824-3600
  • Fax: 308-824-3410
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2735
License Number StateNE

VIII. Authorized Official

Name: MARK MCCURDY
Title or Position: MEMBER
Credential: RP
Phone: 308-697-3400