Provider Demographics
NPI:1639290778
Name:KLAMATH TRIBAL HEALTH & FAMILY SERVICES
Entity Type:Organization
Organization Name:KLAMATH TRIBAL HEALTH & FAMILY SERVICES
Other - Org Name:KLAMATH TRIBAL PHARMACY - CHILOQUIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:541-882-1487
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:CHILOQUIN
Mailing Address - State:OR
Mailing Address - Zip Code:97624-0490
Mailing Address - Country:US
Mailing Address - Phone:541-783-2438
Mailing Address - Fax:541-783-3554
Practice Address - Street 1:330 S CHILOQUIN BLVD
Practice Address - Street 2:
Practice Address - City:CHILOQUIN
Practice Address - State:OR
Practice Address - Zip Code:97624-6747
Practice Address - Country:US
Practice Address - Phone:541-783-2438
Practice Address - Fax:541-783-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2078297OtherPK
OR115761Medicaid
OR115761Medicaid