Healthcare Provider Details

I. General information

NPI: 1457486177
Provider Name (Legal Business Name): DHHS PHS IHS PHOENIX AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PICACHO RD
WINTERHAVEN CA
92283
US

IV. Provider business mailing address

PO BOX 1368
YUMA AZ
85366
US

V. Phone/Fax

Practice location:
  • Phone: 760-572-4742
  • Fax: 760-572-4228
Mailing address:
  • Phone: 760-572-4742
  • Fax: 760-572-4228

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: TRISHA CHAMBERLAIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 760-572-4100