| Organization Name: | PUEBLO PINTADO HEALTH CENTER |
| NPI Number: | 1831212281 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STACY WILLIAMS (CHIEF PHARMACIST) |
| Mailing Address: | Hwy 371 Route 9 Crownpoint |
| State: | NM US |
| Postal Code: | 873130358 |
| Phone Number: | 5057866344 |
| Fax Number: | 5057866440 |
| NPI Enumeration Date: | 04/09/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0002X |
| License Number: | AU4720846 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| 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. |