Healthcare Provider Details

I. General information

NPI: 1124178017
Provider Name (Legal Business Name): PAWNEE IHS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HERITAGE CIR
PAWNEE OK
74058-3744
US

IV. Provider business mailing address

PO BOX 95435
CLEVELAND OH
44101-0033
US

V. Phone/Fax

Practice location:
  • Phone: 918-762-2517
  • Fax: 918-762-4614
Mailing address:
  • Phone: 918-762-2517
  • Fax: 918-762-4614

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 Number521768
License Number StateOK

VIII. Authorized Official

Name: KAILEEN SKIDGEL
Title or Position: AREA PHARMACY CONSULTANT
Credential: PHARMD
Phone: 918-762-6611