Healthcare Provider Details

I. General information

NPI: 1740434844
Provider Name (Legal Business Name): ELY SHOSHONE TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NEWE VIEW
ELY NV
89301-3139
US

IV. Provider business mailing address

400 B NEWE VW
ELY NV
89301-3139
US

V. Phone/Fax

Practice location:
  • Phone: 775-289-4133
  • Fax: 775-289-3890
Mailing address:
  • Phone: 775-289-4133
  • Fax: 775-289-3890

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
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: GARRET EUGENE GARBER
Title or Position: CLINIC SUPERVISOR/PHARMACY MANAGER
Credential: PHARM D
Phone: 775-289-2134