Healthcare Provider Details

I. General information

NPI: 1710010327
Provider Name (Legal Business Name): FORT MOJAVE HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 PLANTATION RD
MOHAVE VALLEY AZ
86440-9686
US

IV. Provider business mailing address

1607 PLANTATION RD
MOHAVE VALLEY AZ
86440-9686
US

V. Phone/Fax

Practice location:
  • Phone: 928-346-4679
  • Fax:
Mailing address:
  • Phone: 928-346-4679
  • Fax:

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

VIII. Authorized Official

Name: SANDRA BROWNSTEIN
Title or Position: CHEIF PHARMACIST
Credential:
Phone: 928-346-4679