Healthcare Provider Details

I. General information

NPI: 1083169544
Provider Name (Legal Business Name): CHOUTEAU FAMILY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N CHOUTEAU AVE
CHOUTEAU OK
74337-3242
US

IV. Provider business mailing address

PO BOX 700
INOLA OK
74036-0700
US

V. Phone/Fax

Practice location:
  • Phone: 918-476-6455
  • Fax: 918-476-6966
Mailing address:
  • Phone: 918-543-8777
  • Fax: 918-543-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAUL ANDREW TURNER
Title or Position: MEMBER / PHARMACIST
Credential:
Phone: 918-543-8777