Provider Demographics
NPI:1063542645
Name:COLVILLE INDIAN HEALTH CENTER PHARMACY
Entity type:Organization
Organization Name:COLVILLE INDIAN HEALTH CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA BUSINESS OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-326-7277
Mailing Address - Street 1:AGENCY CAMPUS HWY 155
Mailing Address - Street 2:PO BOX 71
Mailing Address - City:NESPELEM
Mailing Address - State:WA
Mailing Address - Zip Code:99155
Mailing Address - Country:US
Mailing Address - Phone:509-634-2914
Mailing Address - Fax:509-634-2954
Practice Address - Street 1:AGENCY CAMPUS HWY 155
Practice Address - Street 2:
Practice Address - City:NESPELEM
Practice Address - State:WA
Practice Address - Zip Code:99155
Practice Address - Country:US
Practice Address - Phone:509-634-2914
Practice Address - Fax:509-634-2954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
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
4926284OtherNCPDP NUMBER
WA6021141Medicaid
WA6021141Medicaid