Provider Demographics
NPI:1952437287
Name:CROW INDIAN HOSPITAL PHARMACY
Entity Type:Organization
Organization Name:CROW INDIAN HOSPITAL PHARMACY
Other - Org Name:CROW NORTHERN CHEYENNE HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:AREA BUSINESS OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-247-7184
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:212 HIGHWAY AND I-90 INTERSECTION PO
Mailing Address - City:CROW AGENCY
Mailing Address - State:MT
Mailing Address - Zip Code:59022-0009
Mailing Address - Country:US
Mailing Address - Phone:406-638-3351
Mailing Address - Fax:406-638-3569
Practice Address - Street 1:212 HIGHWAY AND I-90 INTERSECTION
Practice Address - Street 2:
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-638-3351
Practice Address - Fax:406-638-3569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
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
2705513OtherNCPDP NUMBER
MT2210051Medicaid
MT2210051Medicaid