Organization
GILA RIVER HEALTH CARE CORPORATION
Active
Other names
KOMATKE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY CROLL PHARMD (DIRECTOR, PHARMACY)
(602) 528-1200
Entity
Organization
Contact information
Practice address
17487 S HEALTHCARE DR, LAVEEN, AZ 85339-8500
(520) 550-6022
(520) 550-6028
Mailing address
17487 S HEALTHCARE DR, LAVEEN, AZ 85339-8500
(520) 550-6022
(520) 550-6028
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
333600000X
Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1991256
PK
—
05
—
AHCCCS334582
—
AZ
Enumeration date
03/06/2007
Last updated
04/28/2017
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