Healthcare Provider Details

I. General information

NPI: 1528492303
Provider Name (Legal Business Name): PHARMCAREOK OF HYDRO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S ARAPAHO AVENUE
HYDRO OK
73048
US

IV. Provider business mailing address

PO BOX 70
HYDRO OK
73048-0070
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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number205266
License Number StateOK

VIII. Authorized Official

Name: KENT ABBOTT
Title or Position: PRESIDENT
Credential:
Phone: 405-663-4111