Provider Demographics
NPI:1316233570
Name:TRIBAL HOUSE PHARMACY
Entity type:Organization
Organization Name:TRIBAL HOUSE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:907-225-3144
Mailing Address - Street 1:300 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6418
Mailing Address - Country:US
Mailing Address - Phone:907-225-3144
Mailing Address - Fax:
Practice Address - Street 1:300 FRONT ST
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6418
Practice Address - Country:US
Practice Address - Phone:907-225-3144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KETCHIKAN INDIAN CORPORATION TRIBAL HEALTH CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-24
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK476333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPH2696Medicaid
AKPH2696Medicaid