Organization
JOHNNYS HOMETOWN PHARMACY PC
Active
Other names
JOHNNYS HOMETOWN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNY ROBERTS (PRESIDENT)
(918) 427-0400
Entity
Organization
Contact information
Practice address
303 E RAY FINE BLVD, STE 100, ROLAND, OK 74954-5362
(918) 427-0400
(918) 427-0401
Mailing address
PO BOX 1600, ROLAND, OK 74954-1600
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
343841
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100243100A
—
OK
05
—
140896407
—
AR
01
—
2074722
PK
—
Enumeration date
11/23/2005
Last updated
07/10/2014
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