Provider Demographics
NPI:1629476221
Name:CHEROKEE NATION
Entity Type:Organization
Organization Name:CHEROKEE NATION
Other - Org Name:COOWEESCOOWEE HEALTH CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH SYSTEM PHARMACY DIRECTO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-207-4915
Mailing Address - Street 1:395200 W 2900 RD
Mailing Address - Street 2:
Mailing Address - City:OCHELATA
Mailing Address - State:OK
Mailing Address - Zip Code:74051-2463
Mailing Address - Country:US
Mailing Address - Phone:918-207-4915
Mailing Address - Fax:918-458-1211
Practice Address - Street 1:395200 W 2900 RD
Practice Address - Street 2:
Practice Address - City:OCHELATA
Practice Address - State:OK
Practice Address - Zip Code:74051-2463
Practice Address - Country:US
Practice Address - Phone:918-535-6000
Practice Address - Fax:918-458-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9-7213332800000X, 332800000X, 332800000X
333600000X, 3336S0011X, 3336C0004X, 3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149188OtherPK