Healthcare Provider Details

I. General information

NPI: 1720001720
Provider Name (Legal Business Name): HEALTH CENTER PHARMACY OF CLAREMORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E BLUE STARR DRIVE
CLAREMORE OK
74017
US

IV. Provider business mailing address

113 E BLUE STARR DRIVE
CLAREMORE OK
74017
US

V. Phone/Fax

Practice location:
  • Phone: 918-341-1236
  • Fax: 918-341-2070
Mailing address:
  • Phone: 918-341-1236
  • Fax: 918-341-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number294542
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MIKE MILLER
Title or Position: PRESIDENT
Credential:
Phone: 918-341-1236