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General NPI Number Information
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NPI Number | 1629525605
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Entity Type | Organization
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Legal Business Name | CANONCITO BAND OF NAVAJOS HEALTH CENTER, INC
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 129 MEDICINE HORSE ROAD
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City | CANONCITO
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State | NM
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Zip | 87026
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Country | US
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Telephone | 505-908-2307
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Fax | 505-908-2310
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Provider Business Mailing Address
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Address Line | 129 MEDICINE HORSE RD
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City | CANONCITO
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State | NM
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Zip | 87026
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Country | US
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Telephone | 505-908-2307
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Fax | 505-908-2310
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Authorized Official
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Title or Position | LCDR/ CHIEF PHARMACIST
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Name | ALEXANDER VARGA
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Credential |
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Telephone | 505-908-2307
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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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