Organization
WYANDOTTE NATION
Active
Other names
BEARSKIN HEALTH CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA BOETTLER (PHARMACY DIRECTOR)
(918) 678-3244
Entity
Organization
Contact information
Practice address
1 TURTLE DR, WYANDOTTE, OK 74370-2114
(918) 678-3247
(918) 678-3136
Mailing address
1 TURTLE DR, WYANDOTTE, OK 74370-2114
(918) 678-2282
(918) 678-3136
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
21-6044
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100707880G
—
OK
01
—
2137552
PK
—
Enumeration date
10/22/2012
Last updated
07/18/2024
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