Organization
SAM THORNBROUGH
Active
Other names
CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SAM THORNBROUGH (OWNER)
(580) 928-3058
Entity
Organization
Contact information
Practice address
1601 WATTS ST, SAYRE, OK 73662-1314
(580) 928-3058
(580) 928-3873
Mailing address
PO BOX 99, SAYRE, OK 73662-0099
(580) 928-3058
(580) 928-3873
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
351906
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100233760A OK
—
OK
01
—
2073245
PK
—
Enumeration date
10/27/2006
Last updated
06/08/2015
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