Healthcare Provider Details

I. General information

NPI: 1376554931
Provider Name (Legal Business Name): TRUETT GUTHRIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W 4TH ST
HOBART OK
73651-4010
US

IV. Provider business mailing address

100 W 4TH ST
HOBART OK
73651-4010
US

V. Phone/Fax

Practice location:
  • Phone: 580-726-2221
  • Fax: 580-726-3530
Mailing address:
  • Phone: 580-726-2221
  • Fax: 580-726-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4165
License Number StateOK

VIII. Authorized Official

Name: TRUETT GUTHRIE
Title or Position: OWNER
Credential: DPH
Phone: 580-726-2221