Healthcare Provider Details

I. General information

NPI: 1871942896
Provider Name (Legal Business Name): PENDER CARE CENTRE DISTRICT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 18TH ST
WISNER NE
68791-2237
US

IV. Provider business mailing address

PO BOX 100
PENDER NE
68047-0100
US

V. Phone/Fax

Practice location:
  • Phone: 402-529-3550
  • Fax:
Mailing address:
  • Phone: 402-385-3350
  • Fax: 402-385-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number672
License Number StateNE

VIII. Authorized Official

Name: LAURA J GAMBLE
Title or Position: CEO
Credential:
Phone: 402-385-3083