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General NPI Number Information
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NPI Number | 1407252588
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Entity Type | Organization
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Legal Business Name | IHC SANTA YSABEL PHARMACY
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 110 1/2 SCHOOL HOUSE CANYON ROAD
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City | SANTA YSABEL
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State | CA
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Zip | 92070
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Country | US
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Telephone | 760-233-5587
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Fax | 760-765-3769
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | SANTA YSABEL
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State | CA
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Zip | 92070-0010
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Country | US
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Telephone | 760-233-5587
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Fax | 760-765-3769
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | ROBERT SCHOSTAG
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Credential |
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Telephone | 760-749-1410
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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 | PHY46552
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License Number State | CA
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