| NPI | 1194803346 |
|---|---|
| Other Name | KICKAPOO TRIBAL PHARMACY |
| Entity Type | Organization |
| Authorized Contact | JANETTA MAHTAPENE Health Director 405-964-2081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2011-11-02 |