Organization
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Active
Parent organization
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Other names
Salt River Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Authorized official
LAURA A TILLMAN MD (CMO)
(602) 263-1674
Entity
Organization
Contact information
Practice address
10005 E OSBORN RD, SCOTTSDALE, AZ 85256-4019
(480) 946-9066
(480) 946-9415
Mailing address
PO BOX 95460, CLEVELAND, OH 44101-0033
(602) 581-6088
(602) 263-1619
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
01
—
0354679
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
092453
—
AZ
Enumeration date
11/14/2006
Last updated
05/26/2021
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