# GOOD SHEPHERD COMMUNITY CLINIC, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GOOD SHEPHERD COMMUNITY CLINIC, INC.
- **Other names:** Good Shepherd Community Clinic Pharmacy Walnut
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1316529803
- **Legal business name:** GOOD SHEPHERD COMMUNITY CLINIC, INC.
- **Authorized official:** TERESA MYERS (CEO)
- **Authorized official phone:** (580) 223-3411

## Contact information

- **Practice address:** 1104 WALNUT DR W, ARDMORE, OK 73401
- **Practice address phone:** (580) 226-0543
- **Mailing address:** 20 12TH AVE NW, ARDMORE, OK 73401-5722
- **Mailing address phone:** (580) 826-3575
- **Mailing address fax:** (580) 223-5113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 04/23/2021
- **Last updated:** 04/23/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 12-8917 | PHARMACY LICENSE | OK |