Provider Demographics
NPI:1558482935
Name:CONFEDERATED SALISH & KOOTENAI TRIBES OF THE FLATHEAD RESERVATION
Entity type:Organization
Organization Name:CONFEDERATED SALISH & KOOTENAI TRIBES OF THE FLATHEAD RESERVATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSI
Authorized Official - Middle Name:
Authorized Official - Last Name:CAHOON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:406-745-3525
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:ST IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-0880
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 4TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2117
Practice Address - Country:US
Practice Address - Phone:406-883-5482
Practice Address - Fax:406-883-3512
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONFEDERATED SALISH & KOOTENAI TRIBES OF THE FLATHEAD RESERVATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-03
Last Update Date:2025-07-17
Deactivation Date:2007-06-08
Deactivation Code:
Reactivation Date:2017-08-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7097623Medicaid
271810Medicare ID - Type Unspecified