Ponca Tribe of Nebraska

NPI #1760778385 in Omaha, Nebraska

Provider Information

NPI Number
1760778385
Entity Type
Organization
Organization Name
Ponca Tribe of Nebraska
Subpart
Yes (part of a larger organization)
Parent Organization
PONCA TRIBE OF NEBRASKA
Primary Specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Enumeration Date
Jun 22, 2011
Last Updated
Jun 22, 2011

Practice Location

Address
2602 J ST
Address 2
FRED LEROY HEALTH AND WELLNESS CENTER PHARMACY
City
Omaha
ZIP Code
68107-1643
Phone
(402) 734-5275

Authorized Official

Name
MR. DONALD LEE, MS
Title
CHIEF EXECUTIVE OFFICER
Phone
(402) 734-5275

Specialties & Taxonomy Codes

Specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

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