Provider Demographics
NPI:1053476671
Name:PONDER, DANNY (PD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:
Last Name:PONDER
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PONDEROSA CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-5078
Mailing Address - Country:US
Mailing Address - Phone:870-425-5145
Mailing Address - Fax:
Practice Address - Street 1:400 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3923
Practice Address - Country:US
Practice Address - Phone:870-425-5145
Practice Address - Fax:870-424-5104
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD05878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist