Organization
PECHANGA INDIAN HEALTH CLINIC PHARMACY
Active
Other names
Pechanga Indian Health Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM THOMSEN (CEO)
(909) 864-1097
Entity
Organization
Contact information
Practice address
47001 PALA RD, TEMECULA, CA 92592-2925
(951) 676-6810
(951) 676-6421
Mailing address
12784 PECHANGA RD, TEMECULA, CA 92592
(951) 676-6810
(951) 676-6421
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
50823
CA
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5646178
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/31/2012
Last updated
10/07/2021
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