Organization
TECUMSEH MEDICAL CLINIC PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD FISHER (OWNER)
(405) 598-6597
Entity
Organization
Contact information
Practice address
418 E WALNUT ST, SUITE 100, TECUMSEH, OK 74873-2200
(405) 598-6597
(405) 598-6103
Mailing address
418 E WALNUT ST, SUITE 100, TECUMSEH, OK 74873-2200
(405) 598-6597
(405) 598-6103
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
10-5267
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100244260A
—
OK
01
—
2074942
PK
—
Enumeration date
08/19/2006
Last updated
10/16/2017
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