Provider Demographics
NPI:1326198581
Name:HASKELL IHS PHARMACY
Entity type:Organization
Organization Name:HASKELL IHS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OCA PHARMACY CONSULT
Authorized Official - Prefix:
Authorized Official - First Name:KAILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIDGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-762-6611
Mailing Address - Street 1:2415 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2415 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046
Practice Address - Country:US
Practice Address - Phone:785-843-3750
Practice Address - Fax:785-843-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2025-08-08
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
KS2159200002Medicaid
1717478OtherNCPDP PROVIDER IDENTIFICATION NUMBER