NPIMap

Organization Active NPI

Pueblo of Isleta

Doing business as Pueblo of Isleta Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Isleta, NM
National Provider Identifier
1407979008
Registry record updated Aug 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
License
501C Issued in NM
Legal business name
PUEBLO OF ISLETA
Doing business as
Pueblo of Isleta Pharmacy
Practice address
01 Sagebrush St
Isleta, NM 87022-0000
Phone
(505) 869-4863
Fax
(505) 869-4811
NPI assigned
Apr 9, 2007
Last updated
Aug 19, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2026

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

Authorized official

Name
Kimberly Pohl
Title
Ceo
Phone
(505) 869-3200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X 501C NM Primary

Addresses

Primary practice location

01 Sagebrush St
Isleta, NM 87022-0000

Mailing address

01 Sagebrush St
Isleta, NM 87022-0000
Phone (505) 869-4863

Other identifiers 1

IdentifierTypeStateIssuer
00010146MedicaidNM

Other names 1

  • Pueblo of Isleta Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170126001345 NM Part B Supplier - Pharmacy 9739080631 Practice locations: Albuquerque, NM

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pueblo of Isleta9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

1 Sagebrush St SW
Albuquerque, NM 87105
Phone (505) 869-4463

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787097600000",
    "number": "1407979008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "01 SAGEBRUSH ST",
            "city": "ISLETA",
            "state": "NM",
            "postal_code": "870220000",
            "telephone_number": "505-869-4863",
            "fax_number": "505-869-4811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "01 SAGEBRUSH ST",
            "city": "ISLETA",
            "state": "NM",
            "postal_code": "870220000",
            "telephone_number": "505-869-4863",
            "fax_number": "505-869-4811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO OF ISLETA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2026-08-19",
        "certification_date": "2026-08-19",
        "status": "A",
        "authorized_official_last_name": "POHL",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-869-3200"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "NM",
            "license": "501C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00010146",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PUEBLO OF ISLETA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pueblo of Isleta Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Isleta, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.