Organization
GLENPOOL PHARMACY INC
Active
Other names
MEDICAP PHARMACY 8422
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN GREEN (OWNER)
(918) 322-3667
Entity
Organization
Contact information
Practice address
15024 S MEMORIAL DR STE F, BIXBY, OK 74008-3700
(918) 364-7222
(918) 364-7225
Mailing address
PO BOX 887, GLENPOOL, OK 74033-0887
(918) 322-3667
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
26183
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3727180
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/19/2013
Last updated
02/19/2013
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