Organization
KICKAPOO TRIBAL HEALTH CENTER
Active
Other names
KICKAPOO TRIBAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYNE IRION (HEALTH DIRECTOR)
(405) 964-2081
Entity
Organization
Contact information
Practice address
105365 S. HWY 102, BUILDING M, MCLOUD, OK 74851
(405) 964-2081
(405) 964-7160
Mailing address
105365 S. HWY 102, BUILDING M, MCLOUD, OK 74851
(405) 964-2081
(405) 964-7160
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
—
100245200A
—
OK
01
—
3721809
NABP
OK
Enumeration date
11/02/2006
Last updated
10/06/2025
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