# GOOD SHEPHERD COMMUNITY CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Good Shepherd Community Clinic Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730539487
- **Authorized official:** TERESA MYERS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (580) 223-3411

## Contact information

- **Practice address:** 20 12TH AVE NW, ARDMORE, OK 73401-5722
- **Practice address phone:** (580) 223-3411
- **Mailing address:** 20 12TH AVE NW, ARDMORE, OK 73401-5722
- **Mailing address phone:** (580) 223-3411

## Taxonomy

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

## Other

- **Enumeration date:** 06/14/2016
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 12-8483 | OKLAHOMA STATE BOARD OF PHARMACY LICENSE | OK |
| 01 | — | 3729514 | NCPDP | — |