NPIMap

Organization Active NPI

Riverside-San Bernardino County Indian Health Inc

Doing business as San Manuel Indian Health Clinic Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Grand Terrace, CA
National Provider Identifier
1174724637
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
License
PHY52145 Issued in CA
Legal business name
RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH INC
Doing business as
San Manuel Indian Health Clinic Pharmacy
Practice address
11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Phone
(909) 864-1097
Fax
(909) 503-1218
NPI assigned
May 30, 2007
Last updated
Mar 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Authorized official

Name
Jeevan Dhouni, BS
Title
Director of Pharmacy
Phone
(909) 864-1097

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X PHY52145 CA Primary

Addresses

Primary practice location

11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172

Mailing address

11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Phone (909) 864-1097

Other identifiers 1

IdentifierTypeStateIssuer
1993983OtherPK

Other names 1

  • SAN MANUEL INDIAN HEALTH CLINIC PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Riverside San Bernardin20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615248000000",
    "number": "1174724637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11980 MOUNT VERNON AVE",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135172",
            "telephone_number": "909-864-1097",
            "fax_number": "909-503-1218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11980 MOUNT VERNON AVE",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135172",
            "telephone_number": "909-864-1097",
            "fax_number": "909-503-1218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A",
        "authorized_official_last_name": "DHOUNI",
        "authorized_official_first_name": "JEEVAN",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "909-864-1097",
        "authorized_official_credential": "BS"
    },
    "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": "CA",
            "license": "PHY52145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1993983",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAN MANUEL INDIAN HEALTH CLINIC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Terrace, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; 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.