Healthcare Provider Details

I. General information

NPI: 1881616456
Provider Name (Legal Business Name): IOWA TRIBE OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date: 08/12/2008
Reactivation Date: 08/28/2008

III. Provider practice location address

509 E HIGHWAY 33
PERKINS OK
74059-4129
US

IV. Provider business mailing address

PO BOX 460
PERKINS OK
74059-0460
US

V. Phone/Fax

Practice location:
  • Phone: 405-547-2473
  • Fax: 405-547-2925
Mailing address:
  • Phone: 405-547-2473
  • Fax: 405-547-2925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number8-5151
License Number StateOK

VIII. Authorized Official

Name: ANGELA DAWN DAUGHERTY
Title or Position: DIRECTOR OF HEALTH
Credential:
Phone: 405-547-2473