Healthcare Provider Details

I. General information

NPI: 1144359852
Provider Name (Legal Business Name): GILA RIVER HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17487 S HEALTHCARE DR
LAVEEN AZ
85339-8500
US

IV. Provider business mailing address

17487 S HEALTHCARE DR
LAVEEN AZ
85339-8500
US

V. Phone/Fax

Practice location:
  • Phone: 520-550-6022
  • Fax: 520-550-6028
Mailing address:
  • Phone: 520-550-6022
  • Fax: 520-550-6028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: LARRY CROLL
Title or Position: DIRECTOR, PHARMACY
Credential: PHARMD
Phone: 602-528-1200