Provider Demographics
NPI:1235268947
Name:HUHUKAM MEMORIAL HOSPITAL PHARMACY
Entity Type:Organization
Organization Name:HUHUKAM MEMORIAL HOSPITAL PHARMACY
Other - Org Name:GILA RIVER HEALTHCARE CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARGAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-528-1200
Mailing Address - Street 1:483 W SEED FARM RD
Mailing Address - Street 2:PO BOX 38
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85247
Mailing Address - Country:US
Mailing Address - Phone:602-528-1229
Mailing Address - Fax:602-528-1262
Practice Address - Street 1:483 W SEED FARM RD
Practice Address - Street 2:
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85247
Practice Address - Country:US
Practice Address - Phone:602-528-1229
Practice Address - Fax:602-528-1262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0322672OtherNCPDP NUMBER
BH0322672OtherPHARMACY DEA NUMBER