Provider Demographics
NPI:1902012305
Name:MESKWAKI PHARMACY
Entity Type:Organization
Organization Name:MESKWAKI PHARMACY
Other - Org Name:SAC & FOX TRIBE OF THE MISSISSIPPI IN IOWA PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-484-4667
Mailing Address - Street 1:1646 305TH STREET
Mailing Address - Street 2:
Mailing Address - City:TAMA
Mailing Address - State:IA
Mailing Address - Zip Code:52339-9634
Mailing Address - Country:US
Mailing Address - Phone:641-484-4667
Mailing Address - Fax:641-484-4875
Practice Address - Street 1:1646 305TH STREET
Practice Address - Street 2:
Practice Address - City:TAMA
Practice Address - State:IA
Practice Address - Zip Code:52339-9634
Practice Address - Country:US
Practice Address - Phone:641-484-4667
Practice Address - Fax:641-484-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy