MEDICARE: BINTZ 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	3336L0003X	Long Term Care Pharmacy	6-5771	OK

General Provider Information

NPI Number	:	1275072977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BINTZ PHARMACY, INC.

Provider Business Mailing Address
First Line	:	2701 N 14TH ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1738
Country	:	US
Telephone Number	:	580-765-3055
Fax Number	:	580-765-3410

Provider Business Practice Location Address
First Line	:	2701 N 14TH ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1738
Country	:	US
Telephone Number	:	580-765-3055
Fax Number	:	580-765-3410

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. MATT P BINTZ
Credential	:
Telephone Number	:	580-765-3055

Provider Enumeration Date	:	02/15/2017
Last Update Date	:	10/17/2018

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