Healthcare Provider Details

I. General information

NPI: 1790210755
Provider Name (Legal Business Name): SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10005 E OSBORN RD BLDG 61
SCOTTSDALE AZ
85256-4019
US

IV. Provider business mailing address

10005 E OSBORN RD BLDG 61
SCOTTSDALE AZ
85256-4019
US

V. Phone/Fax

Practice location:
  • Phone: 480-946-9227
  • Fax: 480-278-7186
Mailing address:
  • Phone: 480-946-9227
  • Fax: 480-278-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VIOLET MITCHELL-ENOS
Title or Position: DIRECTOR
Credential:
Phone: 480-362-5480