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General NPI Number Information
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NPI Number | 1225155666
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Entity Type | Organization
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Legal Business Name | ZIA INDIAN HEALTH CLINIC PHARMACY
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 155B CAPITOL SQUARE DR
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City | SAN YSIDRO
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State | NM
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Zip | 87053-6013
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Country | US
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Telephone | 505-867-5258
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Fax | 505-771-9452
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Provider Business Mailing Address
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Address Line | PO BOX 95459
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City | CLEVELAND
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State | OH
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Zip | 44101-0033
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Country | US
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Telephone | 505-248-7771
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DARRELL MILLER
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Credential |
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Telephone | 505-248-7773
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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 |
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License Number State |
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