Organization
FORT YATES INDIAN HOSP PHARMACY
Active
Other names
FORT YATES INDIAN HOSPITAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES CUMMINGS PHARMD (PHARMACY PROGRAM SPECIALIST)
(405) 951-6086
Entity
Organization
Contact information
Practice address
1010 N RIVER RD, FORT YATES, ND 58538
(701) 854-8251
(701) 854-3523
Mailing address
3113 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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001058
—
ND
05
—
1058FO
—
ND
01
—
3503833
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
5549040
—
SD
Enumeration date
03/06/2007
Last updated
03/07/2013
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