Organization
CLINIC PHARMACY OF CORDELL INC
Active
Other names
Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS JOHNSON (PHARMACY MANAGER)
(580) 832-3714
Entity
Organization
Contact information
Practice address
1213 N GLENN ENGLISH ST, CORDELL, OK 73632-2009
(580) 832-3714
(580) 832-3331
Mailing address
1213 N GLENN ENGLISH ST, CORDELL, OK 73632-2009
(580) 832-3714
(580) 832-3331
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
33-7414
OK
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200608360A
—
OK
01
—
2154068
PK
—
Enumeration date
07/29/2015
Last updated
02/20/2017
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