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Organization
KAW NATION
Active
Organization
KAW NATION
Active
Other names
KANZA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOANNA GAYLE POTTER (HEALTH DIRECTOR)
(580) 362-1039
Entity
Organization
Contact information
Practice address
3151 E RIVER RD, NEWKIRK, OK 74647
(580) 362-2449
(580) 362-1405
Mailing address
PO BOX 474, 3151 E RIVER RD, NEWKIRK, OK 74647
(580) 362-2449
(580) 362-1405
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
6-4338
OK
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100245620A
—
OK
Enumeration date
04/02/2007
Last updated
03/13/2025
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