Organization
PAWNEE HILLCREST PHARMACY ENTERPRISES, LLC
Active
Other names
Pawnee Hillcrest Pharmacy Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BROOKE LYNN TATUM DPH (OWNER/PHARMACIST)
(918) 762-3666
Entity
Organization
Contact information
Practice address
539 6TH STREET, PAWNEE, OK 74058-2542
(918) 762-3666
(918) 762-2288
Mailing address
539 6TH STREET, PAWNEE, OK 74058-2542
(918) 762-3666
(918) 762-2288
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
522742
OK
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100238450A
—
OK
01
—
2073056
PK
—
Enumeration date
09/30/2006
Last updated
02/28/2019
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