Organization
GOOD SHEPHERD COMMUNITY CLINIC, INC
Active
Other names
Good Shepherd Community Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA MYERS (EXECUTIVE DIRECTOR)
(580) 223-3411
Entity
Organization
Contact information
Practice address
20 12TH AVE NW, ARDMORE, OK 73401-5722
(580) 223-3411
Mailing address
20 12TH AVE NW, ARDMORE, OK 73401-5722
(580) 223-3411
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12-8483
OKLAHOMA STATE BOARD OF PHARMACY LICENSE
OK
01
—
3729514
NCPDP
—
Enumeration date
06/14/2016
Last updated
03/07/2023
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