Organization
WAGNER INDIAN HEALTH CARE PHARMACY
Active
Other names
WAGNER INDIAN HEALTH CARE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES CUMMINGS (PHARMACY PROGRAM SPECIALIST)
(405) 951-6086
Entity
Organization
Contact information
Practice address
111 WASHINGTON AVE NW, WAGNER, SD 57380-4300
(605) 384-3621
(605) 384-5229
Mailing address
3116 SOLUTIONS CTR, CHICAGO, IL 60677-3001
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
3860
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4304844
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
SD5540030
—
SD
Enumeration date
03/06/2007
Last updated
02/20/2013
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