Healthcare Provider Details

I. General information

NPI: 1639290778
Provider Name (Legal Business Name): KLAMATH TRIBAL HEALTH & FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S CHILOQUIN BLVD
CHILOQUIN OR
97624-6747
US

IV. Provider business mailing address

PO BOX 490
CHILOQUIN OR
97624-0490
US

V. Phone/Fax

Practice location:
  • Phone: 541-783-2438
  • Fax: 541-783-3554
Mailing address:
  • Phone: 541-783-2438
  • Fax: 541-783-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY GEORGE LANGFORD
Title or Position: PHARMACY DIRECTOR
Credential: PHARMD
Phone: 541-882-1487