Healthcare Provider Details

I. General information

NPI: 1508945486
Provider Name (Legal Business Name): GUYMON CLINIC PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 N LELIA ST
GUYMON OK
73942-3647
US

IV. Provider business mailing address

PO BOX 1590
GUYMON OK
73942-1590
US

V. Phone/Fax

Practice location:
  • Phone: 580-338-3339
  • Fax: 580-338-1010
Mailing address:
  • Phone: 580-338-3339
  • Fax: 580-338-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number435014
License Number StateOK

VIII. Authorized Official

Name: CHET OBLANDER
Title or Position: PARTNER
Credential:
Phone: 580-338-3339