National Provider Identifier Database

WAGNER INDIAN HEALTH CARE 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

WAGNER INDIAN HEALTH CARE PHARMACY
111 WASHINGTON AVE NW
WAGNER, SD57380-4300
Phone: 605-384-3621
Fax: 605-384-5229
Website:
Specialty Taxonomy Code
* Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X

* Indicates primary specialty

NPI Profile & details for WAGNER INDIAN HEALTH CARE PHARMACY

NPI Number 1548390115
Legal business name
LBN
WAGNER INDIAN HEALTH CARE PHARMACY
Authorized official JAMES CUMMINGS - (PHARMACY PROGRAM SPECIALIST)
Entity Organization
Organization subpart No
Enumeration date 03/06/2007
Last updated 02/20/2013 - About 13 years ago
Sole proprietor1 Not specified
Identifiers
  • SD License #: 3860
  • SD Medicaid: SD5540030
  • Other: 4304844 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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