Healthcare Provider Details

I. General information

NPI: 1396660197
Provider Name (Legal Business Name): COMPASSION CLINIC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 S 13TH ST
KINGFISHER OK
73750-4217
US

IV. Provider business mailing address

PO BOX 255
KINGFISHER OK
73750-0255
US

V. Phone/Fax

Practice location:
  • Phone: 405-375-4283
  • Fax:
Mailing address:
  • Phone: 580-614-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY BRACK
Title or Position: PIC
Credential:
Phone: 580-614-1293