=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952437287
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CROW INDIAN HOSPITAL PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 212 HIGHWAY AND I-90 INTERSECTION
-----------------------------------------------------
City | CROW AGENCY
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-638-3351
-----------------------------------------------------
Fax | 406-638-3569
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9 212 HIGHWAY AND I-90 INTERSECTION PO
-----------------------------------------------------
City | CROW AGENCY
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59022-0009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-638-3351
-----------------------------------------------------
Fax | 406-638-3569
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AREA BUSINESS OFFICE COORDINATOR
-----------------------------------------------------
Name | CYNTHIA LARSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-247-7184
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332800000X
-----------------------------------------------------
Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------