Provider Demographics
NPI:1124178017
Name:PAWNEE IHS PHARMACY
Entity type:Organization
Organization Name:PAWNEE IHS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AREA PHARMACY CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:KAILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIDGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:918-762-6611
Mailing Address - Street 1:PO BOX 95435
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-0033
Mailing Address - Country:US
Mailing Address - Phone:918-762-2517
Mailing Address - Fax:918-762-4614
Practice Address - Street 1:1201 HERITAGE CIR
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-3744
Practice Address - Country:US
Practice Address - Phone:918-762-2517
Practice Address - Fax:918-762-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK521768332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3723029OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OK100231960EMedicaid