Healthcare Provider Details

I. General information

NPI: 1265931612
Provider Name (Legal Business Name): FARMERS UNION HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 3RD ST
ELK CITY OK
73644-5145
US

IV. Provider business mailing address

PO BOX 2339
ELK CITY OK
73648-2339
US

V. Phone/Fax

Practice location:
  • Phone: 580-821-5390
  • Fax: 580-821-5568
Mailing address:
  • Phone: 580-225-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number35-5427
License Number StateOK

VIII. Authorized Official

Name: THERESA GARNER
Title or Position: DIR OF PHARMACY
Credential:
Phone: 580-821-5579