Organization
GLN OF HOLDENVILLE, INC
Active
Other names
NICHOLS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN L SUMMERS DPH (PHARMACIST IN CHARGE)
(405) 379-3381
Entity
Organization
Contact information
Practice address
203 E HIGHWAY ST, HOLDENVILLE, OK 74848-4011
(405) 379-3381
(405) 379-3962
Mailing address
203 E HIGHWAY ST, HOLDENVILLE, OK 74848-4011
(405) 379-3381
(405) 379-3962
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
40-4623
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200002680A
—
OK
01
—
3713650
NCPDP
OK
Enumeration date
12/28/2005
Last updated
01/24/2011
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