Healthcare Provider Details

I. General information

NPI: 1326165994
Provider Name (Legal Business Name): SANTA DOMINGO IHS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 SAN ILDEFONSO ST
SANTA DOMINGO NM
87052
US

IV. Provider business mailing address

PO BOX 31001-0664
PASADENA CA
91110-0664
US

V. Phone/Fax

Practice location:
  • Phone: 505-465-3060
  • Fax: 505-465-1155
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: PAMELA SCHWEITZER
Title or Position: IHS PHARMACY CONSULTANT
Credential: PHARMD
Phone: 602-364-5277