Healthcare Provider Details

I. General information

NPI: 1285706721
Provider Name (Legal Business Name): YELLOWHAWK TRIBAL HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46314 TIMINE WAY
PENDLETON OR
97801-9417
US

IV. Provider business mailing address

PO BOX 160
PENDLETON OR
97801-0160
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax:
Mailing address:
  • Phone: 541-966-9830
  • 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 Number
License Number StateOR

VIII. Authorized Official

Name: KRISTI LAPP
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 541-240-8722