Provider Demographics
NPI:1427180009
Name:SANDIA HEALTH CLINIC PHARMACY
Entity Type:Organization
Organization Name:SANDIA HEALTH CLINIC PHARMACY
Other - Org Name:SANDIA HEALTH CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IHS PHARMACY CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWEITZER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:602-364-5277
Mailing Address - Street 1:PO BOX 31001-0673
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-0675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:481 SANDIA LOOP
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-7076
Practice Address - Country:US
Practice Address - Phone:505-867-4487
Practice Address - Fax:505-771-5126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10462Medicaid
3209295OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NMH7890Medicaid