Healthcare Provider Details

I. General information

NPI: 1477688190
Provider Name (Legal Business Name): DHHS IHS PHOENIX AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6822 E 1000 S
FORT DUCHESNE UT
84026
US

IV. Provider business mailing address

PO BOX 160
FORT DUCHESNE UT
84026-0160
US

V. Phone/Fax

Practice location:
  • Phone: 435-725-6874
  • Fax: 435-725-6889
Mailing address:
  • Phone: 435-725-5122
  • 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 State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARY LYNNE OLDCOYOTE
Title or Position: CHIEF OPERATING OFFICER
Credential: COO
Phone: 435-725-6811