Organization · Type 2 NPI

PHS Indian Hospital

Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy · Red Lake, MN

NPI number 1063549822 Active

Practice location

24670 Hospital Drive
Red Lake, MN 56671

Call (218) 679-0173 Map

Fax (218) 679-0189

Mailing address

4100 W. 150th St, Lb: 95419
Cleveland, OH 44135

Specialties and licenses

Taxonomy	Code	License
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy Primary	332800000X	2604653 (MN)
Durable Medical Equipment & Medical Supplies	332B00000X	None listed
Clinic Pharmacy	3336C0002X	None listed
Specialty Pharmacy	3336S0011X	None listed

Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy: An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.

Other indian health service/tribal/urban indian health (i/t/u) pharmacy providers in Red Lake

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NPI record

NPI: 1063549822
Entity type: Organization (Type 2)
Issued: Feb 28, 2007
Last updated: Jan 19, 2024
Status: Active

Other names

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Red Lake Indian Hospital Pharmacy · doing business as
Red Lake Indian Hospital Pharmacy · doing business as

Authorized official

Jan Thunder
Business Office Manager
(218) 679-0148

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1063549822

PHS Indian Hospital's National Provider Identifier is 1063549822, issued on Feb 28, 2007. The primary taxonomy on file is Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy (332800000X), and the practice location is in Red Lake, MN. The record was last updated on Jan 19, 2024.