Organization
BRODERICK ENTERPRISES, LLC
Active
Other names
McCortney's Family Pharmacy & Compounding Center, Vintage Drug Company
Organization subpart
No
Provider details
NPI number
Authorized official
ZACK BRODERICK PHARMD (PHARMACIST/OWER)
(580) 332-3344
Entity
Organization
Contact information
Practice address
711 E 9TH ST, ADA, OK 74820-3807
(580) 332-3344
(580) 332-3616
Mailing address
711 E 9TH ST, ADA, OK 74820-3807
(580) 332-3344
(580) 332-3616
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
23-8228
OK
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200803550A
—
OK
Enumeration date
08/01/2018
Last updated
10/03/2025
Update your record
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