Healthcare Provider Details

I. General information

NPI: 1023004215
Provider Name (Legal Business Name): HUTTON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N MAIN ST
BLACKWELL OK
74631-2226
US

IV. Provider business mailing address

PO BOX 110
BLACKWELL OK
74631-0110
US

V. Phone/Fax

Practice location:
  • Phone: 580-363-2137
  • Fax: 580-363-5582
Mailing address:
  • Phone: 580-363-2137
  • Fax: 580-363-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number61743
License Number StateOK

VIII. Authorized Official

Name: DENNIS HUTTON
Title or Position: OWNER
Credential:
Phone: 580-363-2137