Organization
UNITED PHARMACY OF MANGUM LLC
Active
Other names
UNITED PHARMACY OF MANGUM
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY BANISTER PHRMD (OWNER AND PHARMACIST)
(580) 782-5400
Entity
Organization
Contact information
Practice address
1000 N LOUIS TITTLE AVE, MANGUM, OK 73554-2210
(580) 782-5400
(580) 782-5404
Mailing address
1000 N LOUIS TITTLE AVE, MANGUM, OK 73554-2210
(580) 782-5400
(580) 782-5404
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60-4910
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200046200A
—
OK
01
—
2076977
PK
—
Enumeration date
01/16/2007
Last updated
05/25/2016
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