Healthcare Provider Details

I. General information

NPI: 1093847451
Provider Name (Legal Business Name): SANTA FE INDIAN HOSPITAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/03/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CERRILLOS RD
SANTA FE NM
87505-3554
US

IV. Provider business mailing address

SANTA FE INDIAN HOSPITAL PO BOX 395446
CLEVELAND OH
44135
US

V. Phone/Fax

Practice location:
  • Phone: 505-946-9389
  • Fax: 505-982-7065
Mailing address:
  • Phone: 412-644-7702
  • 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: RUSSELL SANDOVAL
Title or Position: ACCOUNTING
Credential:
Phone: 505-988-9821