MEDICARE: FORT MOJAVE HEALTH CENTER PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332800000X	Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0352283	OTHER		NCPDP NUMBER

General Provider Information

NPI Number	:	1710010327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT MOJAVE HEALTH CENTER PHARMACY

Provider Business Mailing Address
First Line	:	1607 PLANTATION RD
Second Line	:
City	:	MOHAVE VALLEY
State	:	AZ
Zip	:	86440-9686
Country	:	US
Telephone Number	:	928-346-4679
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 PLANTATION RD
Second Line	:
City	:	MOHAVE VALLEY
State	:	AZ
Zip	:	86440-9686
Country	:	US
Telephone Number	:	928-346-4679
Fax Number	:

Authorized Official
Title or Position	:	CHEIF PHARMACIST
Name	:	SANDRA BROWNSTEIN
Credential	:
Telephone Number	:	928-346-4679

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	02/10/2025

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