Healthcare Provider Details

I. General information

NPI: 1629476221
Provider Name (Legal Business Name): CHEROKEE NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395200 W 2900 RD
OCHELATA OK
74051-2463
US

IV. Provider business mailing address

395200 W 2900 RD
OCHELATA OK
74051-2463
US

V. Phone/Fax

Practice location:
  • Phone: 918-535-6000
  • Fax: 918-458-1211
Mailing address:
  • Phone: 918-207-4915
  • Fax: 918-458-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number9-7213
License Number StateOK

VIII. Authorized Official

Name: JEFF SANDERS
Title or Position: HEALTH SYSTEM PHARMACY DIRECTO
Credential:
Phone: 918-207-4915