Provider Demographics
NPI:1356673040
Name:PONCA TRIBE OF NEBRASKA
Entity Type:Organization
Organization Name:PONCA TRIBE OF NEBRASKA
Other - Org Name:FRED LEROY HEALTH AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHUFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:402-734-5275
Mailing Address - Street 1:2602 J ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1643
Mailing Address - Country:US
Mailing Address - Phone:402-734-5275
Mailing Address - Fax:402-734-5708
Practice Address - Street 1:2602 J ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1643
Practice Address - Country:US
Practice Address - Phone:402-734-5275
Practice Address - Fax:402-734-5708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy