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Organization
GOOD SHEPHERD COMMUNITY CLINIC, INC.
Active
Organization
GOOD SHEPHERD COMMUNITY CLINIC, INC.
Active
Parent organization
GOOD SHEPHERD COMMUNITY CLINIC, INC.
Other names
Good Shepherd Community Clinic Pharmacy Walnut
Organization subpart
Yes
Provider details
NPI number
Legal business name
GOOD SHEPHERD COMMUNITY CLINIC, INC.
Authorized official
TERESA MYERS (CEO)
(580) 223-3411
Entity
Organization
Contact information
Practice address
1104 WALNUT DR W, ARDMORE, OK 73401
(580) 226-0543
Mailing address
20 12TH AVE NW, ARDMORE, OK 73401-5722
(580) 826-3575
(580) 223-5113
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12-8917
PHARMACY LICENSE
OK
Enumeration date
04/23/2021
Last updated
04/23/2021
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