Organization
CHICKASHA CLINIC PHARMACY LLC
Active
Other names
Chickasha Clinic Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE JUSTICE (AUTHORIZED AGENT)
(405) 447-3911
Entity
Organization
Contact information
Practice address
2224 W IOWA AVE, CHICKASHA, OK 73018-2738
(405) 224-4851
(405) 222-9157
Mailing address
2224 W IOWA AVE, CHICKASHA, OK 73018-2738
(405) 224-4851
(405) 222-9157
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
18-5929
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100236490A
—
OK
01
—
2135238
PK
—
Enumeration date
12/11/2006
Last updated
06/08/2022
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