SAN MANUEL INDIAN HEALTH CLINIC PHARMACY
NPI 1174724637
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Grand Terrace, CA

Q: What is Riverside-San Bernardino County Indian Health Inc's specialty?

The primary specialty registered for this NPI is Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy with taxonomy code 332800000X.

Active since May 30, 2007

11980 MOUNT VERNON AVE, GRAND TERRACE, CA 92313(909) 864-1097(909) 503-1218 Get Directions Write a Review

NPPES record last updated: March 9, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 9, 2021, Jul 19, 2018, Apr 30, 2018 and 1 more (4 updates tracked since 2017).

On this page

About San Manuel Indian Health Clinic Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAN MANUEL INDIAN HEALTH CLINIC PHARMACY (NPI 1174724637) is a healthcare organization registered as an indian health service/tribal/urban indian health (i/t/u) pharmacy in Grand Terrace, California and active in the NPI registry since May 2007. The organization lists Jeevan Dhouni, Director Of Pharmacy, as its authorized official.

NPPES Registry Identity

NPI1174724637

Entity TypeOrganization

Primary Taxonomy332800000X

Legal Business NameRIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH INC

Location Address11980 MOUNT VERNON AVEGrand Terrace, CA 92313-5172

Mailing Address11980 Mount Vernon AveGrand Terrace, CA 92313-5172 · (909) 864-1097 · Fax (909) 503-1218

Phone(909) 864-1097

Fax(909) 503-1218

Organization SubpartNo

Authorized OfficialJeevan DhouniDirector Of Pharmacy · (909) 864-1097

Enumeration DateMay 30, 2007

Last NPPES UpdateMarch 9, 20214 updates tracked since enumeration

NPPES CertifiedMarch 9, 2021

✔ NPI 1174724637 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyIndian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacySuppliers

Taxonomy Code332800000X

License✔ Licensed in CA · PHY52145

Definition

An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.

Also ListedPharmacyTaxonomy 333600000X

11980 MOUNT VERNON AVE, Grand Terrace, CA 92313

Open in Google Maps ↗

Other Names 1

Doing Business AsSan Manuel Indian Health Clinic Pharmacy

Other Identifiers 1

Other1993983Pk

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness and more.Insurance ›

Leave this field empty

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NOEMI AVILA

Nurse Practitioner (Pediatrics)