Healthcare Provider Details

I. General information

NPI: 1982782256
Provider Name (Legal Business Name): UNITED INDIAN HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WEEOT WAY
ARCATA CA
95521-4734
US

IV. Provider business mailing address

1600 WEEOT WAY
ARCATA CA
95521-4734
US

V. Phone/Fax

Practice location:
  • Phone: 707-825-5020
  • Fax: 707-825-6879
Mailing address:
  • Phone: 707-825-4177
  • Fax: 707-825-6879

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 Number45313
License Number StateCA

VIII. Authorized Official

Name: KANAKO MIYAMOTO
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 707-825-4095