Healthcare Provider Details

I. General information

NPI: 1780988907
Provider Name (Legal Business Name): GUTHRIE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W NOBLE AVE
GUTHRIE OK
73044-3123
US

IV. Provider business mailing address

102 W NOBLE AVE
GUTHRIE OK
73044-3123
US

V. Phone/Fax

Practice location:
  • Phone: 405-282-7800
  • Fax: 405-282-2244
Mailing address:
  • Phone: 405-282-7800
  • Fax: 405-282-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number32-5603
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

VIII. Authorized Official

Name: JOHN DOUGLAS LASSITER
Title or Position: OWNER
Credential: D.PH.
Phone: 405-677-0549