Organization
PRAIRIE BAND POTAWATOMI NATION
Active
Parent organization
PRAIRIE BAND POTAWATOMI NATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRAIRIE BAND POTAWATOMI NATION
Authorized official
MIKE CARPENTER RPH (CHIEF PHARMACIST)
(785) 966-8266
Entity
Organization
Contact information
Practice address
11400 158TH RD, MAYETTA, KS 66509-8866
(866) 727-6330
(785) 966-8396
Mailing address
11400 158TH RD, MAYETTA, KS 66509-0249
(785) 966-8200
(785) 966-8396
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
2-2546
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200259300B
—
KS
01
—
2027266
PK
—
Enumeration date
07/25/2006
Last updated
01/23/2018
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