Organization
HAISTEN ENTERPRISES PC
Active
Other names
Pocola Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CLAY T HAISTEN (OWNER)
(918) 436-2900
Entity
Organization
Contact information
Practice address
102 E FOLSOM BLVD, POCOLA, OK 74902-3150
(918) 436-2900
(918) 436-7070
Mailing address
102 E FOLSOM BLVD, POCOLA, OK 74902-3150
(918) 436-2900
(918) 436-7070
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
194449
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100244270A
—
OK
Enumeration date
07/25/2007
Last updated
06/17/2008
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