NPIMap

Organization Active NPI

Gila River Health Care Corporation

Doing business as Komatke Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Laveen, AZ
National Provider Identifier
1144359852
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
Legal business name
GILA RIVER HEALTH CARE CORPORATION
Doing business as
Komatke Pharmacy
Practice address
17487 S Healthcare Dr
Laveen, AZ 85339-8500
Phone
(520) 550-6022
Fax
(520) 550-6028
NPI assigned
Mar 6, 2007
Last updated
Apr 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Larry Croll, PHARMD
Title
Director, Pharmacy
Phone
(602) 528-1200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X NU Primary

Addresses

Primary practice location

17487 S Healthcare Dr
Laveen, AZ 85339-8500

Mailing address

17487 S Healthcare Dr
Laveen, AZ 85339-8500
Phone (520) 550-6022

Other identifiers 2

IdentifierTypeStateIssuer
AHCCCS334582MedicaidAZ
1991256OtherPK

Other names 1

  • KOMATKE PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Huhukam Memorial Hospit23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1144359852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17487 S HEALTHCARE DR",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853398500",
            "telephone_number": "520-550-6022",
            "fax_number": "520-550-6028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17487 S HEALTHCARE DR",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853398500",
            "telephone_number": "520-550-6022",
            "fax_number": "520-550-6028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILA RIVER HEALTH CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "CROLL",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "DIRECTOR, PHARMACY",
        "authorized_official_telephone_number": "602-528-1200",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AHCCCS334582",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1991256",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KOMATKE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laveen, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.