Provider Demographics
NPI:1003036096
Name:CHEROKEE PHARMACY
Entity Type:Organization
Organization Name:CHEROKEE PHARMACY
Other - Org Name:EASTERN BAND OF CHEROKEE INDIANS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROGRAM MANAGER URGENT CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERRI
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:BS BA
Authorized Official - Phone:828-497-9036
Mailing Address - Street 1:PO BOX 2039
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719-2039
Mailing Address - Country:US
Mailing Address - Phone:828-497-9244
Mailing Address - Fax:828-497-3838
Practice Address - Street 1:75 PAINTOWN ROAD
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719
Practice Address - Country:US
Practice Address - Phone:828-497-9244
Practice Address - Fax:828-497-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332800000X, 3336C0003X
NC07038333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0875089OtherMEDICARE ID TYPE SPECIFIC
3435256OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0875089Medicare ID - Type Unspecified