Organization
CHICKASAW NATION DIVISION OF HEALTH
Active
Other names
TISHOMINGO INDIAN CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ZACH WILLIAMS DPH (PHARMACIST)
(580) 272-2710
Entity
Organization
Contact information
Practice address
817 E 6TH ST, TISHOMINGO, OK 73460-1800
(580) 371-2392
(580) 421-4552
Mailing address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 421-4597
(580) 421-4598
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
61-6174
OK
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100244600B
—
OK
01
—
2074771
PK
—
Enumeration date
03/20/2007
Last updated
02/10/2015
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