Provider Demographics
NPI:1467581819
Name:CATAWBA INDIAN HLTH CTR PHARMACY
Entity Type:Organization
Organization Name:CATAWBA INDIAN HLTH CTR PHARMACY
Other - Org Name:CATAWBA INDIAN HLTH CTR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST PROGRAM SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:405-951-6086
Mailing Address - Street 1:PO BOX 534346
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-4346
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2893 STURGIS RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-6607
Practice Address - Country:US
Practice Address - Phone:803-366-9090
Practice Address - Fax:803-366-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2015-03-23
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
2092756OtherPK
BC8910110OtherDEA NUMBER