Provider Demographics
NPI:1790656148
Name:INDIAN HEALTH SERVICE MONACAN SERVICE UNIT MONACAN HEALTH CENTER
Entity type:Organization
Organization Name:INDIAN HEALTH SERVICE MONACAN SERVICE UNIT MONACAN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARLILE-MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:434-895-6856
Mailing Address - Street 1:108 DIXIE AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-4500
Mailing Address - Country:US
Mailing Address - Phone:434-895-6672
Mailing Address - Fax:
Practice Address - Street 1:108 DIXIE AIRPORT RD
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-4500
Practice Address - Country:US
Practice Address - Phone:434-895-6672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIAN HEALTH SERVICE MONACAN SERVICE UNIT MONACAN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy