Organization
CANONCITO BAND OF NAVAJOS HEALTH CENTER, INC
Active
Other names
Canoncito Band of Navajos Health Center, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER VARGA (LCDR/ CHIEF PHARMACIST)
(505) 908-2307
Entity
Organization
Contact information
Practice address
129 MEDICINE HORSE ROAD, CANONCITO, NM 87026
(505) 908-2307
(505) 908-2310
Mailing address
129 MEDICINE HORSE RD, CANONCITO, NM 87026
(505) 908-2307
(505) 908-2310
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
—
1124119698
—
NM
05
—
1205092160
—
NM
05
—
1295726073
—
NM
05
—
1619061090
—
TX
05
—
1962591669
—
NM
01
—
2166309
PK
—
Enumeration date
09/07/2016
Last updated
02/21/2017
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