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General NPI Number Information
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NPI Number | 1669786257
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Entity Type | Organization
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Legal Business Name | POKAGON BAND OF POTAWATOMI INDIANS
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 32652 KNO DR
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City | DOWAGIAC
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State | MI
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Zip | 49047
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Country | US
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Telephone | 269-782-4570
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Fax | 269-782-2996
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Provider Business Mailing Address
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Address Line | 32652 KNO DR
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City | DOWAGIAC
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State | MI
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Zip | 49047
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Country | US
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Telephone | 269-782-4570
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Fax | 269-782-2996
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Authorized Official
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Title or Position | DIRECTOR
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Name | PRISCILLA GATTIES
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Credential |
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Telephone | 269-462-4403
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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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