Healthcare Provider Details

I. General information

NPI: 1396580676
Provider Name (Legal Business Name): COLLINSVILLE FAMILY PHARMACY LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W MAIN ST STE A
COLLINSVILLE OK
74021-3114
US

IV. Provider business mailing address

1205 W MAIN ST STE A
COLLINSVILLE OK
74021-3114
US

V. Phone/Fax

Practice location:
  • Phone: 918-371-2547
  • Fax: 918-371-0268
Mailing address:
  • Phone: 918-371-2547
  • Fax: 918-371-0268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. COLTON B TURNBULL
Title or Position: OWNER
Credential:
Phone: 918-371-2547