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General NPI Number Information
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NPI Number | 1952303190
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Entity Type | Organization
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Legal Business Name | PAWHUSKA IHS PHARMACY
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 715 GRANDVIEW AVE
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City | PAWHUSKA
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State | OK
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Zip | 74056-3201
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Country | US
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Telephone | 918-287-4491
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Fax | 918-287-2347
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Provider Business Mailing Address
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Address Line | PO BOX 676748
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City | DALLAS
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State | TX
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Zip | 75267-6748
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AREA PHARMACY CONSULTANT
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Name | TRACIE PATTEN
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Credential | PHARMD
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Telephone | 405-951-6035
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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 | 162939
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License Number State | OK
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