Organization
SHAWNEE REGIONAL PHARMACY INC
Active
Other names
THE CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY BARRICK (OWNER MANAGER OFFICER)
(405) 273-9417
Entity
Organization
Contact information
Practice address
3210 KETHLEY RD, SHAWNEE, OK 74804-9625
(405) 273-9417
(405) 273-8849
Mailing address
3210 KETHLEY RD, SHAWNEE, OK 74804-9625
(405) 273-9417
(405) 273-8849
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
105520
OK
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100235610A
—
OK
01
—
2073679
PK
—
Enumeration date
11/07/2006
Last updated
05/11/2015
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