Organization
MEDICAL PARK CENTER PHARMACY INC
Active
Other names
MEDICAL PARK CENTER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT MOORE DPH (OWNER)
(918) 331-2525
Entity
Organization
Contact information
Practice address
3400 E FRANK PHILLIPS BLVD, STE 203, BARTLESVILLE, OK 74006-2495
(918) 331-2525
(918) 331-2589
Mailing address
3400 E FRANK PHILLIPS BLVD, STE 203, BARTLESVILLE, OK 74006-2495
(918) 331-2525
(918) 331-2589
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9-2507
OK
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100237130A
—
OK
01
—
2073828
PK
—
Enumeration date
09/22/2006
Last updated
12/22/2016
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