Healthcare Provider Details

I. General information

NPI: 1023042314
Provider Name (Legal Business Name): HARRAH PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 N CHURCH AVE
HARRAH OK
73045-0247
US

IV. Provider business mailing address

PO BOX 247
HARRAH OK
73045-0247
US

V. Phone/Fax

Practice location:
  • Phone: 405-454-2476
  • Fax: 405-454-3507
Mailing address:
  • Phone: 405-454-2476
  • Fax: 405-454-3507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8116
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number3739
License Number StateTX

VIII. Authorized Official

Name: DR. AMOS E MALONE
Title or Position: PHARMACIST
Credential: DPH
Phone: 405-454-2476