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General NPI Number Information
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NPI Number | 1912030768
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Entity Type | Organization
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Legal Business Name | DHHS PHS NAIHS CHINLE COMPREHENSIVE HEALTH CARE FACILITY
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | NR 4 2 MI EAST OF PINON
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City | PINON
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State | AZ
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Zip | 86510
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Country | US
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Telephone | 928-725-9514
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Fax | 928-725-9542
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Provider Business Mailing Address
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Address Line | CHINLE HEALTH CARE PO BOX 31001-0651
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City | PASADENA
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State | CA
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Zip | 91110-0651
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Country | US
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Telephone | 928-725-9500
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Fax | 928-725-9805
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Authorized Official
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Title or Position | ADMIN OFFICER
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Name | TILDA SMITH
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Credential | PHRMD
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Telephone | 928-725-9538
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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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