Organization
PONDERS GASSVILLE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANNY PONDER PD CDM (OWNER)
(870) 425-5145
Entity
Organization
Contact information
Practice address
7337 HIGHWAY 62 W, GASSVILLE, AR 72635-8636
(870) 435-5757
(870) 435-5758
Mailing address
7337 HIGHWAY 62 W, GASSVILLE, AR 72635-8636
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR20338
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0421634
OTHER ID NUMBER
—
Enumeration date
08/31/2006
Last updated
07/31/2007
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