National Provider Identifier Database

JICARILLA IHS PHARMACY
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.


Contact Information

JICARILLA IHS PHARMACY
500 N MUNDO DR
DULCE, NM87528-5176
Phone: 505-759-3291
Fax: 505-759-3532
Website:
Specialty Taxonomy Code
* Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X

* Indicates primary specialty

NPI Profile & details for JICARILLA IHS PHARMACY

NPI Number 1124220900
Legal business name
LBN
JICARILLA IHS PHARMACY
Authorized official JAMES CUMMINGS - (PHARMACY PROGRAM SPECIALIST)
Entity Organization
Organization subpart No
Enumeration date 06/04/2007
Last updated 03/02/2023 - About 3 years ago
Sole proprietor1 Not specified
Identifiers
  • NM Medicaid: 000K3526
  • Other: 3210248 NCPDP PROVIDER IDENTIFICATION NUMBER

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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