| NPI | 1003251638 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | CRYSTAL CONTRERAS Billing 801-359-2256  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy (Licence: UT 8547079-1704)  | 
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy | 
| Enumeration Date | 2013-05-09 | 
| Last Update Date | 2017-12-21 |