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Organization
RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH INC
Active
Organization
RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH INC
Active
Other names
SAN MANUEL INDIAN HEALTH CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JEEVAN DHOUNI BS (DIRECTOR OF PHARMACY)
(909) 864-1097
Entity
Organization
Contact information
Practice address
11980 MOUNT VERNON AVE, GRAND TERRACE, CA 92313-5172
(909) 864-1097
(909) 503-1218
Mailing address
11980 MOUNT VERNON AVE, GRAND TERRACE, CA 92313-5172
(909) 864-1097
(909) 503-1218
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
PHY52145
CA
333600000X
Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1993983
PK
—
Enumeration date
05/30/2007
Last updated
03/09/2021
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