Basic Information
| Provider Information | |||||||||
| NPI: | 1235268947 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HUHUKAM MEMORIAL HOSPITAL PHARMACY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GILA RIVER HEALTHCARE CORPORATION | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 483 W SEED FARM RD | ||||||||
| Address2: | PO BOX 38 | ||||||||
| City: | SACATON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025281229 | ||||||||
| FaxNumber: | 6025281262 | ||||||||
| Practice Location | |||||||||
| Address1: | 483 W SEED FARM RD | ||||||||
| Address2: | |||||||||
| City: | SACATON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025281229 | ||||||||
| FaxNumber: | 6025281262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BHARGAVA | ||||||||
| AuthorizedOfficialFirstName: | MEENA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHARMACY DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6025281200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332800000X | Y | Suppliers | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 0322672 | 01 | NCPDP NUMBER | OTHER | BH0322672 | 01 | PHARMACY DEA NUMBER | OTHER |