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General NPI Number Information
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NPI Number | 1881616456
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Entity Type | Organization
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Legal Business Name | IOWA TRIBE OF OKLAHOMA
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 509 E HIGHWAY 33
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City | PERKINS
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State | OK
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Zip | 74059-4129
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Country | US
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Telephone | 405-547-2473
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Fax | 405-547-2925
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Provider Business Mailing Address
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Address Line | PO BOX 460
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City | PERKINS
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State | OK
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Zip | 74059-0460
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Country | US
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Telephone | 405-547-2473
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Fax | 405-547-2925
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Authorized Official
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Title or Position | DIRECTOR OF HEALTH
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Name | ANGELA DAWN DAUGHERTY
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Credential |
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Telephone | 405-547-2473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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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 | 8-5151
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License Number State | OK
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