Organization
GFJ INC
Active
Other names
Broken Arrow Family Drug North
Organization subpart
No
Provider details
NPI number
Authorized official
TODD PENDERGRAFT (PRESIDENT)
(918) 451-3784
Entity
Organization
Contact information
Practice address
1030 E LANSING ST, BROKEN ARROW, OK 74012-2073
(918) 251-3784
(918) 294-1004
Mailing address
3359 S ELM PL, BROKEN ARROW, OK 74012-7924
(918) 451-3784
(918) 451-2295
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-6087
OK
3336I0012X
Institutional Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100812690D
—
OK
01
—
2137360
PK
—
Enumeration date
10/19/2012
Last updated
12/02/2019
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