Organization
PUEBLO OF SAN FELIPE
Active
Other names
SAN FELIPE HEALTH CLINIC PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
DARYL CANDELARIA PHARMD RPH (TRIBAL ADMIN)
(505) 867-3381
Entity
Organization
Contact information
Practice address
3 CEDAR ST, SAN FELIPE PUEBLO, SAN FELIPE, NM 87001
(505) 867-5485
(505) 771-9940
Mailing address
PO BOX 4342, PO BOX 4339, SAN FELIPE, NM 87001
(505) 867-9616
(505) 771-9940
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
—
2058717
PK
—
05
—
81271875
—
NM
Enumeration date
09/21/2006
Last updated
06/11/2018
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