Healthcare Provider Details

I. General information

NPI: 1073923645
Provider Name (Legal Business Name): BUFFALO PHARMACY MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 N HOY
BUFFALO OK
73834
US

IV. Provider business mailing address

PO BOX 679
BUFFALO OK
73834-0679
US

V. Phone/Fax

Practice location:
  • Phone: 580-735-2161
  • Fax: 580-735-2230
Mailing address:
  • Phone: 580-735-2161
  • Fax: 580-735-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number716715
License Number StateOK

VIII. Authorized Official

Name: GREG HUENERGARDT
Title or Position: PRESIDENT
Credential:
Phone: 580-938-2854