Provider Demographics
NPI:1225483522
Name:INDIAN HEALTH SERVICE-WEWOKA
Entity Type:Organization
Organization Name:INDIAN HEALTH SERVICE-WEWOKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:405-257-7345
Mailing Address - Street 1:JCT HWYS 56 & 270
Mailing Address - Street 2:
Mailing Address - City:WEWOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74848
Mailing Address - Country:US
Mailing Address - Phone:405-257-7361
Mailing Address - Fax:
Practice Address - Street 1:JCT HWYS 56 & 270
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884
Practice Address - Country:US
Practice Address - Phone:405-257-7361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0202205912261QP0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal