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Organization
CHICKASAW NATION DIVISION OF HEALTH
Active
Organization
CHICKASAW NATION DIVISION OF HEALTH
Active
Other names
TISHOMINGO INDIAN CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ZACH WILLIAMS DPH (PHARMACIST)
(580) 272-2710
Entity
Organization
Contact information
Practice address
817 E 6TH ST, TISHOMINGO, OK 73460-1800
(580) 371-2392
(580) 421-4552
Mailing address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 421-4597
(580) 421-4598
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
61-6174
OK
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100244600B
—
OK
01
—
2074771
PK
—
Enumeration date
03/20/2007
Last updated
02/10/2015
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