Healthcare Provider Details

I. General information

NPI: 1538298989
Provider Name (Legal Business Name): GALLUP INDIAN MED CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 08/05/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

PO BOX 31001-0650
PASADENA CA
91110-0650
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1185
  • Fax: 505-722-1554
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 Number
License Number State

VIII. Authorized Official

Name: ERICA HARKER
Title or Position: AREA PHARMACY CONSULTANT
Credential: PHARMD
Phone: 928-871-5873