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	3336C0004X	Compounding Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy	6-5771	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2127193	OTHER	PK

General Provider Information

NPI Number	:	1841255379
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 BINTZ
Credential	:
Telephone Number	:	580-765-3055

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	08/10/2020

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Directions to “BINTZ PHARMACY, INC. ” Practice Location

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