Healthcare Provider Details

I. General information

NPI: 1063542645
Provider Name (Legal Business Name): COLVILLE INDIAN HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AGENCY CAMPUS HWY 155
NESPELEM WA
99155
US

IV. Provider business mailing address

AGENCY CAMPUS HWY 155 PO BOX 71
NESPELEM WA
99155
US

V. Phone/Fax

Practice location:
  • Phone: 509-634-2914
  • Fax: 509-634-2954
Mailing address:
  • Phone: 509-634-2914
  • Fax: 509-634-2954

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: DAVID BATTESE
Title or Position: AREA BUSINESS OFFICE COORDINATOR
Credential:
Phone: 503-326-7277