Healthcare Provider Details

I. General information

NPI: 1952437287
Provider Name (Legal Business Name): CROW INDIAN HOSPITAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 HIGHWAY AND I-90 INTERSECTION
CROW AGENCY MT
59022
US

IV. Provider business mailing address

PO BOX 9 212 HIGHWAY AND I-90 INTERSECTION PO
CROW AGENCY MT
59022-0009
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-3351
  • Fax: 406-638-3569
Mailing address:
  • Phone: 406-638-3351
  • Fax: 406-638-3569

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 Number
License Number State

VIII. Authorized Official

Name: CYNTHIA LARSEN
Title or Position: AREA BUSINESS OFFICE COORDINATOR
Credential:
Phone: 406-247-7184