Provider Demographics
NPI:1003500240
Name:INDIAN HEALTH SERVICE RICHMOND SERVICE UNIT
Entity Type:Organization
Organization Name:INDIAN HEALTH SERVICE RICHMOND SERVICE UNIT
Other - Org Name:MONACAN HEALTH CENTER TRIBAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:REMEDIOS
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-622-0011
Mailing Address - Street 1:108 DIXIE AIRPORT RD.
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-5973
Mailing Address - Country:US
Mailing Address - Phone:804-622-0011
Mailing Address - Fax:804-622-0010
Practice Address - Street 1:108 DIXIE AIRPORT RD.
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-5973
Practice Address - Country:US
Practice Address - Phone:804-622-0011
Practice Address - Fax:804-622-0010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-ATLANTIC TRIBAL HEALTH CENTER PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-08
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy