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Organization
GOOD SHEPHERD COMMUNITY CLINIC, INC
Active
Organization
GOOD SHEPHERD COMMUNITY CLINIC, INC
Active
Other names
Good Shepherd Community Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA MYERS (EXECUTIVE DIRECTOR)
(580) 223-3411
Entity
Organization
Contact information
Practice address
20 12TH AVE NW, ARDMORE, OK 73401-5722
(580) 223-3411
Mailing address
20 12TH AVE NW, ARDMORE, OK 73401-5722
(580) 223-3411
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12-8483
OKLAHOMA STATE BOARD OF PHARMACY LICENSE
OK
01
—
3729514
NCPDP
—
Enumeration date
06/14/2016
Last updated
03/07/2023
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