Healthcare Provider Details

I. General information

NPI: 1295867612
Provider Name (Legal Business Name): HYPERION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N MAIN ST
EUFAULA OK
74432-1634
US

IV. Provider business mailing address

605 N MAIN ST
EUFAULA OK
74432-1634
US

V. Phone/Fax

Practice location:
  • Phone: 918-689-9940
  • Fax: 918-689-7557
Mailing address:
  • Phone: 918-689-9940
  • Fax: 918-689-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number48-5526
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
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DARREN TIDWELL
Title or Position: OWNER
Credential:
Phone: 918-689-9940