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Organization
ZIA INDIAN HEALTH CLINIC PHARMACY
Active
Organization
ZIA INDIAN HEALTH CLINIC PHARMACY
Active
Other names
ZIA INDIAN HEALTH CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DARRELL MILLER (CHIEF EXECUTIVE OFFICER)
(505) 248-7773
Entity
Organization
Contact information
Practice address
155B CAPITOL SQUARE DR, SAN YSIDRO, NM 87053-6013
(505) 867-5258
(505) 771-9452
Mailing address
PO BOX 95459, CLEVELAND, OH 44101-0033
(505) 248-7771
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11115
—
NM
01
—
3209269
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/22/2007
Last updated
02/07/2025
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