Organization
CITIZAN POTAWATOMI NATION MAIL ORDER PHARMACY
Active
Other names
CPN MAIL ORDER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL HALL (ADMIN)
(405) 273-5236
Entity
Organization
Contact information
Practice address
2307 GORDON COOPER DR STE A, SHAWNEE, OK 74801-9007
(405) 273-5236
(405) 878-4835
Mailing address
2307 GORDON COOPER DR STE A, SHAWNEE, OK 74801-9007
(405) 273-5236
(405) 878-4835
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
Primary
10-5052
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2077052
PK
—
Enumeration date
06/11/2006
Last updated
10/19/2016
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