=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316866452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TUOLUMNE ME-WUK INDIAN HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2026
-----------------------------------------------------
Last Update Date | 07/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14520 MONO WAY STE 100
-----------------------------------------------------
City | SONORA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95370-7828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-928-5407
-----------------------------------------------------
Fax | 209-928-5413
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14520 MONO WAY STE 100
-----------------------------------------------------
City | SONORA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95370-7828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-928-5407
-----------------------------------------------------
Fax | 209-928-5413
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY DIRECTOR
-----------------------------------------------------
Name | JOO YEUN HALLIDAY
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 209-928-5407
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------