Healthcare Provider Details

I. General information

NPI: 1538298773
Provider Name (Legal Business Name): YERINGTON TRIBAL CLINIC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 CAMPBELL LN
YERINGTON NV
89447-9731
US

IV. Provider business mailing address

171 CAMPBELL LN
YERINGTON NV
89447-9731
US

V. Phone/Fax

Practice location:
  • Phone: 775-463-3335
  • Fax: 775-463-2416
Mailing address:
  • Phone: 775-463-3335
  • Fax: 775-463-2416

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: MR. DELMAR THURMAN STEVENS
Title or Position: TRIBAL CHAIRMAN
Credential:
Phone: 775-463-3301