Healthcare Provider Details

I. General information

NPI: 1659451953
Provider Name (Legal Business Name): PHARM BLANCHARD ACQUISITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NE 10TH ST
BLANCHARD OK
73010-9817
US

IV. Provider business mailing address

PO BOX 2090 301 NE 10TH STREET
BLANCHARD OK
73010-2090
US

V. Phone/Fax

Practice location:
  • Phone: 405-485-9311
  • Fax: 405-485-9312
Mailing address:
  • Phone: 405-485-9311
  • Fax: 405-485-9312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number47-7319
License Number StateOK

VIII. Authorized Official

Name: MATTHEW FINN
Title or Position: OFFICER
Credential:
Phone: 469-261-3048