Organization
UPPER MATTAPONI INDIAN TRIBE
Active
Parent organization
UPPER MATTAPONI INDIAN TRIBE
Other names
UMT Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
UPPER MATTAPONI INDIAN TRIBE
Authorized official
STEVEN TUPPONCE (CEO)
(804) 238-9922
Entity
Organization
Contact information
Practice address
27 COMMERCE LN, KING WILLIAM, VA 23086
(804) 769-2015
Mailing address
27 COMMERCE LN, KING WILLIAM, VA 23086
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30015299710005
—
VA
Enumeration date
05/03/2024
Last updated
07/22/2025
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