Healthcare Provider Details

I. General information

NPI: 1558482935
Provider Name (Legal Business Name): CONFEDERATED SALISH & KOOTENAI TRIBES OF THE FLATHEAD RESERVATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date: 06/08/2007
Reactivation Date: 08/15/2017

III. Provider practice location address

5 4TH AVE E
POLSON MT
59860-2117
US

IV. Provider business mailing address

PO BOX 880
ST IGNATIUS MT
59865-0880
US

V. Phone/Fax

Practice location:
  • Phone: 406-883-5482
  • Fax: 406-883-3512
Mailing address:
  • Phone:
  • Fax:

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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JESSI CAHOON
Title or Position: PHARMACY DIRECTOR
Credential: PHARMD
Phone: 406-745-3525