| Organization Name: | SAN MANUEL INDIAN HEALTH CLINIC PHARMACY |
| NPI Number: | 1174724637 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JESS MONTOYA (CEO) |
| Mailing Address: | 11980 Mount Vernon Ave Grand Terrace |
| State: | CA US |
| Postal Code: | 923135172 |
| Phone Number: | 9098641097 |
| Fax Number: | 9095031218 |
| NPI Enumeration Date: | 05/30/2007 |
| NPI Last Update Date: | 03/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0002X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Clinic Pharmacy |
| Taxonomy Definition: | A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |