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General NPI Number Information
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NPI Number | 1063678779
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Entity Type | Organization
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Legal Business Name | THREE AFFILIATED TRIBES MANADREE HEALTH CARE TELE-PHARMACY
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 305 MAIN STREET
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City | MANDAREE
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State | ND
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Zip | 58757
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Country | US
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Telephone | 701-759-3151
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Fax | 701-759-3181
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Provider Business Mailing Address
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Address Line | PO BOX 625
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City | MANDAREE
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State | ND
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Zip | 58757-0625
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Country | US
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Telephone | 701-759-3151
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Fax | 701-759-3181
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Authorized Official
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Title or Position | CHIEF TELEPHARMACIST
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Name | DONNA BIERI
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Credential |
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Telephone | 701-938-3459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number | 775
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License Number State | ND
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