Organization
CHICKASAW NATION DIVISION OF HEALTH
Active
Other names
ARDMORE INDIAN CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ZACH WILLIAMS DPH (PHARMACIST)
(580) 272-5710
Entity
Organization
Contact information
Practice address
2510 CHICKASAW BLVD, ARDMORE, OK 73401-1341
(580) 272-5710
(580) 272-5711
Mailing address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 421-4597
(580) 421-4598
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
123425
OK
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100244600A
—
OK
01
—
2074770
PK
—
Enumeration date
03/21/2007
Last updated
08/19/2016
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