Healthcare Provider Details

I. General information

NPI: 1285653337
Provider Name (Legal Business Name): DEER CREEK PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 ARAPAHO ST
HYDRO OK
73048
US

IV. Provider business mailing address

PO BOX 130
HYDRO OK
73048
US

V. Phone/Fax

Practice location:
  • Phone: 405-663-4111
  • Fax: 405-663-4114
Mailing address:
  • Phone: 405-663-4111
  • Fax: 405-663-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. BARNEY KENT ABBOTT
Title or Position: CEO PRES
Credential:
Phone: 405-663-4111