Provider Demographics
NPI:1760532394
Name:DEPT. OF PUBLIC HEALTH PHARMACY-NRCHC
Entity Type:Organization
Organization Name:DEPT. OF PUBLIC HEALTH PHARMACY-NRCHC
Other - Org Name:NORTHERN REGION COMM. HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH SERVICES ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:UNPINGCO
Authorized Official - Last Name:DENORCEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:671-635-7492
Mailing Address - Street 1:PO BOX 2816
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-2816
Mailing Address - Country:US
Mailing Address - Phone:671-635-7492
Mailing Address - Fax:671-635-7493
Practice Address - Street 1:520 W SANTA MONICA AVE
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-5286
Practice Address - Country:US
Practice Address - Phone:671-635-7492
Practice Address - Fax:671-635-7493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU11-P020261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU654Medicaid
GU5412426OtherNCPDP NUMBER