Organization
GLENPOOL PHARMACY INC
Active
Other names
Medicap Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN GREEN DPH (OWNER PHARMACIST)
(918) 322-3667
Entity
Organization
Contact information
Practice address
262 E 141ST STREET, GLENPOOL, OK 74033
(918) 322-3667
(918) 322-5923
Mailing address
PO BOX 887, GLENPOOL, OK 74033-0887
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
23831
OK
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100239390A
—
OK
05
—
100239390B
—
OK
01
—
3714549
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
90003921020
—
OK
Enumeration date
12/08/2006
Last updated
03/07/2023
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