Provider Demographics
NPI:1538298773
Name:YERINGTON TRIBAL CLINIC PHARMACY
Entity Type:Organization
Organization Name:YERINGTON TRIBAL CLINIC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRIBAL CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DELMAR
Authorized Official - Middle Name:THURMAN
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-463-3301
Mailing Address - Street 1:171 CAMPBELL LN
Mailing Address - Street 2:
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447-9731
Mailing Address - Country:US
Mailing Address - Phone:775-463-3335
Mailing Address - Fax:775-463-2416
Practice Address - Street 1:171 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-9731
Practice Address - Country:US
Practice Address - Phone:775-463-3335
Practice Address - Fax:775-463-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
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
2978697OtherNCPDP NUMBER
AW1555210OtherPHARMACY DEA