Healthcare Provider Details

I. General information

NPI: 1275683369
Provider Name (Legal Business Name): WHITE CLOUD IHS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 THRASHER RD
WHITE CLOUD KS
66094-4028
US

IV. Provider business mailing address

PO BOX 676715
DALLAS TX
75267-6715
US

V. Phone/Fax

Practice location:
  • Phone: 785-595-3450
  • Fax: 785-595-3493
Mailing address:
  • Phone:
  • 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 Number112656
License Number StateKS

VIII. Authorized Official

Name: TRACIE PATTEN
Title or Position: IHS AREA PHARMACY CONSULTANT
Credential: PHARMD
Phone: 405-951-6035