Provider Demographics
NPI:1285706721
Name:YELLOWHAWK TRIBAL HEALTH CENTER PHARMACY
Entity type:Organization
Organization Name:YELLOWHAWK TRIBAL HEALTH CENTER PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-240-8722
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0160
Mailing Address - Country:US
Mailing Address - Phone:541-966-9830
Mailing Address - Fax:
Practice Address - Street 1:46314 TIMINE WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9417
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTRZ021OtherMEDICARE
OR165441Medicaid