Healthcare Provider Details

I. General information

NPI: 1831208719
Provider Name (Legal Business Name): CREEK NATION HOSPITAL & CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 EUNICE BURNS RD
EUFAULA OK
74432-4052
US

IV. Provider business mailing address

MCN PHARMACY DEPT # 1249
TULSA OK
74182-0001
US

V. Phone/Fax

Practice location:
  • Phone: 918-689-2547
  • Fax: 918-756-2464
Mailing address:
  • Phone: 918-756-9909
  • Fax: 918-756-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number484151
License Number StateOK

VIII. Authorized Official

Name: DUSTY ALLEN
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 918-756-9909