MEDICARE: HARRAH PHARMACY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	8116	OK
2	1835N1003X	Nutrition Support Pharmacist	3739	TX

General Provider Information

NPI Number	:	1023042314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRAH PHARMACY INC.

Provider Business Mailing Address
First Line	:	PO BOX 247
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-0247
Country	:	US
Telephone Number	:	405-454-2476
Fax Number	:	405-454-3507

Provider Business Practice Location Address
First Line	:	2060 N CHURCH AVE
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-0247
Country	:	US
Telephone Number	:	405-454-2476
Fax Number	:	405-454-3507

Authorized Official
Title or Position	:	PHARMACIST
Name	:	DR. AMOS E MALONE
Credential	:	DPH
Telephone Number	:	405-454-2476

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	09/11/2025

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1316597040 — AMANDA SAUVILLER LPC-S
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Directions to “HARRAH PHARMACY INC. ” Practice Location

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