# STATE OF OKLAHOMA DEPT. OF HUMAN SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Oklahoma Resource Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609963800
- **Authorized official:** MR. WILLIAM E JOHNSON (PROGRAMS MANAGER)
- **Authorized official phone:** (405) 521-3565

## Contact information

- **Practice address:** RT 1 BOX 44A, PAULS VALLEY, OK 73075
- **Practice address phone:** (405) 238-6401
- **Mailing address:** RT 1 BOX 44A, PAULS VALLEY, OK 73075
- **Mailing address phone:** (405) 238-6401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 10/07/2006
- **Last updated:** 08/22/2020