JICARILLA IHS PHARMACY (NPI# 1124220900) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124220900 |
| Entity Type | Organization |
| Organization Name | JICARILLA IHS PHARMACY |
| Other Organization Name | DULCE IHS PHARMACY |
| Practice Address |
12000 Stone Lake Rd Dulce NM 87528 |
| Mailing Address |
Po Box 31001-0665 Pasadena CA 91110-0665 |
| Practice Telephone | 5057593291 |
| Practice Fax Number | 5057593532 |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2013-03-05 |
| Authorized Official Name | JAMES CUMMINGS (PHARMACY PROGRAM SPECIALIST) |
| Authorized Official Telephone | 4059516086 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP PROVIDER IDENTIFICATION NUMBER | 3210248 | 01 | |
| NM | 000K3526 | 05 |
| Other Name | Type Code |
|---|---|
| DULCE IHS PHARMACY | Doing Business As Name - Organization |
| Street Address |
12000 STONE LAKE RD |
| City | DULCE |
| State | NM |
| Zip Code | 87528 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508832791 | Kristine S Williams | Dietitian, Registered | 12000 Stone Lake Rd, Dulce Health Center, Dulce, NM 87528 | 2006-02-27 |
| 1710210455 | Carolyn Lieb | Pharmacy Technician | 12000 Stone Lake Rd, Dulce, NM 87528-0187 | 2009-09-14 |
| 1598985798 | John E Shumack | Pharmacist | 12000 Stone Lake Rd, Dulce, NM 87528 | 2007-04-27 |
| 1922178359 | Robert Patrick Sewell | Dentist | 12000 Stone Lake Rd, Dulce, NM 87528 | 2006-11-09 |
| 1346326600 | Jicarilla Apache Health Care Facility | Clinic/Center | 12000 Stone Lake Rd, Dulce, NM 87528-0187 | 2006-10-30 |
| 1427160282 | Susan Frances Donlon | Registered Nurse | 12000 Stone Lake Rd, Dulce, NM 87528 | 2006-08-31 |
| 1194834242 | Katherine E Berry | Dental Hygienist | 12000 Stone Lake Rd, Jicarilla Apache Health Care Facility, Ihs, Dulce, NM 87528-0000 | 2006-08-30 |
| 1255347043 | Gaylia Dianne Pride | Registered Nurse | 12000 Stone Lake Rd, Dulce, NM 87528 | 2006-07-31 |
| 1003820069 | Jicarilla Health Care Facility | Clinic/Center | 12000 Stone Lake Rd, Dulce, NM 87528 | 2006-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164917373 | Kelly Rae Pettigrew | Optometrist | 505 North Mundo, Dulce, NM 87528 | 2018-06-29 |
| 1780003442 | Jacob Alexander | Preventive Medicine | 500 N. Mundo, Dulce, NM 87528 | 2014-04-09 |
| 1881020089 | Jicarilla Apache Nation | Clinic/Center | 450 N Mundo Dr., Dulce, NM 87528 | 2013-09-19 |
| 1285971515 | Samuel Taylor Cropp | Pharmacist | 500 N Mundo Dr, Dulce, NM 87528 | 2013-01-07 |
| 1720331697 | Northwest Reional Education Coop #2 | Student in an Organized Health Care Education/Training Program | 91 Hawk Drive, Dulce, NM 87528 | 2012-10-17 |
| 1306116066 | Michael Shawn Kennedy | Psychologist | 113 Hawk Dr, Dulce, NM 87528 | 2012-01-11 |
| 1669762043 | Veronica A Medlin | Technician, Pathology | 1200 Stone Lake Rd, Dulce, NM 87528 | 2011-04-19 |
| 1891085262 | Stella Elizabeth Wilson | Spec/Tech, Pathology | 500 Stone Lake Road, Dulce, NM 87528 | 2011-04-19 |
| 1134419518 | Ray Morris Joe | Technician, Pathology | 500 North Mundo Road, Dulce, NM 87528 | 2011-04-19 |
| 1801186341 | Raquel Irene Cisneros | Family Medicine | 500 N. Mundo Dr., Dulce, NM 87528 | 2011-04-18 |
| Find all providers in zip 87528 | ||||
| Taxonomy Code | 332800000X |
| Grouping | Suppliers |
| Classification | 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. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629525605 | Canoncito Band of Navajos Health Center, Inc | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 129 Medicine Horse Road, Canoncito, NM 87026 | 2016-09-07 |
| 1326165994 | Santa Domingo Ihs Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 340 San Ildefonso St, Santa Domingo, NM 87052 | 2007-03-26 |
| 1225155666 | Zia Indian Health Clinic Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 155b Capitol Square Dr, San Ysidro, NM 87053-6013 | 2007-03-22 |
| 1154453413 | Santa Ana Health Clinic Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 02 C Dove Rd, Bernalillo, NM 87004 | 2007-03-12 |
| 1023148608 | Crownpoint Health Care Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Hwy Jct 57 Rt 9, Crownpoint, NM 87313-0358 | 2007-03-06 |
| 1750425484 | Mescalero Ihs Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 318 Abalonie Loop, Mescalero, NM 88340 | 2007-02-16 |
| 1073671194 | Pine Hill Health Center | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Bia Rt 125, Pine Hill, NM 87357 | 2006-12-04 |
| 1609116573 | Pueblo of Sandia | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 203 Sandia Day School Road, Bernalillo, NM 87004-7076 | 2013-02-28 |
| 1194002345 | Kewa Pueblo Health Corporation | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 85 W Highway 22, Santo Domingo, NM 87052-0340 | 2011-11-15 |
| 1407979008 | Pueblo of Isleta | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 01 Sagebrush St, Isleta, NM 87022-0000 | 2007-04-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.