Organization
PHILLIP W & PHYLLIS J MELTON
Active
Other names
CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP MELTON RPH (OWNER)
(405) 247-3081
Entity
Organization
Contact information
Practice address
1104 E CENTRAL BLVD, SUITE 1, ANADARKO, OK 73005-4406
(405) 247-3081
(405) 247-3081
Mailing address
1104 E CENTRAL BLVD, SUITE 1, ANADARKO, OK 73005-4406
(405) 247-3081
(405) 247-3081
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
20-4065
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100804450E
—
OK
01
—
2075827
PK
—
Enumeration date
09/30/2006
Last updated
09/01/2016
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