OrganizationActive
Riverside-San Bernardino County Indian Health Inc
NPI 1174724637 · Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy · Grand Terrace, CA
Provider details
- NPI number
- 1174724637
- Entity type
- Organization
- Primary specialty
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Jeevan Dhouni, Director of Pharmacy(909) 864-1097
Specialties & taxonomies
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyPrimary332800000XLicense PHY52145 (CA)
Suppliers
- Pharmacy333600000X
Suppliers
Practice location
11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Phone: (909) 864-1097
Fax: (909) 503-1218
Approximate (ZIP-level) locationGet directions
Mailing address
11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Other names (DBA / former)
- Doing business as
- San Manuel Indian Health Clinic Pharmacy
Registry dates
- Enumerated
- 2007-05-30
- Last updated
- 2021-03-09
- Certified
- 2021-03-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.