Organization
ENID PHARMACY MANAGEMENT INC
Active
Other names
MEDIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY S HUENERGARDT DPH (CO OWNER)
(580) 938-2854
Entity
Organization
Contact information
Practice address
1925 W OWEN K GARRIOTT RD, ENID, OK 73703-5528
(580) 242-3784
(580) 237-4199
Mailing address
1925 W OWEN K GARRIOTT RD, ENID, OK 73703-5528
(580) 242-3784
(580) 237-4199
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
55616
OK
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3725011
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/02/2007
Last updated
08/19/2013
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