Healthcare Provider Details

I. General information

NPI: 1154453413
Provider Name (Legal Business Name): SANTA ANA HEALTH CLINIC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

02 C DOVE RD
BERNALILLO NM
87004
US

IV. Provider business mailing address

PO BOX 95458
CLEVELAND OH
44101-0033
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-2497
  • Fax: 505-867-1526
Mailing address:
  • Phone: 505-248-7771
  • 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 Number
License Number State

VIII. Authorized Official

Name: DARRELL MILLER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 505-248-7773