Healthcare Provider Details

I. General information

NPI: 1366455420
Provider Name (Legal Business Name): SAC & FOX NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2 BOX 247
STROUD OK
74079-9652
US

IV. Provider business mailing address

RR 2 BOX 247
STROUD OK
74079-9652
US

V. Phone/Fax

Practice location:
  • Phone: 918-968-9531
  • Fax: 918-968-0113
Mailing address:
  • Phone: 918-968-9531
  • Fax: 918-968-0113

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: MS. JANE RICH
Title or Position: PHARMACY MANAGER
Credential:
Phone: 918-968-9531