Healthcare Provider Details

I. General information

NPI: 1275033474
Provider Name (Legal Business Name): ELGIN PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12889 COMMERCE DR
ELGIN OK
73538-3869
US

IV. Provider business mailing address

12889 COMMERCE DR
ELGIN OK
73538-3869
US

V. Phone/Fax

Practice location:
  • Phone: 580-492-5007
  • Fax: 580-492-5090
Mailing address:
  • Phone: 580-492-5007
  • Fax: 580-492-5090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3-5152
License Number StateOK

VIII. Authorized Official

Name: DR. BRENDAN MATTHEW JONES
Title or Position: MEMBER
Credential: PHARMD
Phone: 580-492-5007