Provider Demographics
NPI:1093847451
Name:SANTA FE INDIAN HOSPITAL PHARMACY
Entity type:Organization
Organization Name:SANTA FE INDIAN HOSPITAL PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-988-9821
Mailing Address - Street 1:SANTA FE INDIAN HOSPITAL
Mailing Address - Street 2:PO BOX 395446
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135
Mailing Address - Country:US
Mailing Address - Phone:412-644-7702
Mailing Address - Fax:
Practice Address - Street 1:1700 CERRILLOS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3554
Practice Address - Country:US
Practice Address - Phone:505-946-9389
Practice Address - Fax:505-982-7065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB3759Medicaid
NMH1232Medicaid
3209219OtherNCPDP PROVIDER IDENTIFICATION NUMBER