Healthcare Provider Details

I. General information

NPI: 1326198219
Provider Name (Legal Business Name): WATONGA IHS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/08/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 CLARENCE NASH RD.
WATONGA OK
73772
US

IV. Provider business mailing address

1305 CLARENCE NASH RD.
WATONGA OK
73772
US

V. Phone/Fax

Practice location:
  • Phone: 580-623-4991
  • Fax: 580-623-5490
Mailing address:
  • Phone:
  • Fax:

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 Number49-2937
License Number StateOK

VIII. Authorized Official

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