=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306740683
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA CAMILLE POGGENDORF
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2026
-----------------------------------------------------
Last Update Date | 10/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 821 W OKLAHOMA AVE STE 2
-----------------------------------------------------
City | GRAND ISLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68801-6781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-381-1690
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 N CLAY AVE
-----------------------------------------------------
City | CLAY CENTER
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68933-1119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-483-4666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 201759
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------