Organization
KINGFISHER PHARMACY MANAGEMENT PLLC
Active
Other names
Medic Pharmacy and Gifts
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY HUENERGARDT (MEMBER MANAGER)
(580) 938-2854
Entity
Organization
Contact information
Practice address
119 W ADMIRE AVE, KINGFISHER, OK 73750-2609
(405) 375-3202
(405) 375-6739
Mailing address
119 W ADMIRE AVE, KINGFISHER, OK 73750-2609
(405) 375-3202
(405) 375-6739
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
54-5617
OK
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200323020A
—
OK
01
—
2128250
PK
—
Enumeration date
01/04/2011
Last updated
01/20/2015
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