Healthcare Provider Details

I. General information

NPI: 1699881540
Provider Name (Legal Business Name): TUOLUMNE ME-WUK INDIAN HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18880 CHERRY VALLEY BLVD.
TUOLUMNE CA
95379-9506
US

IV. Provider business mailing address

18880 CHERRY VALLEY BLVD.
TUOLUMNE CA
95379-9506
US

V. Phone/Fax

Practice location:
  • Phone: 209-928-5400
  • Fax: 209-928-5413
Mailing address:
  • Phone: 209-928-5400
  • Fax: 209-928-5413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY48230
License Number StateCA

VIII. Authorized Official

Name: JOO YEUN SEO
Title or Position: PHARMACY DIRECTOR
Credential: RPH
Phone: 209-928-5407