Healthcare Provider Details

I. General information

NPI: 1578657987
Provider Name (Legal Business Name): CLINICAL CARE PHARMACY OF OWASSO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S MAIN ST
OWASSO OK
74055-3108
US

IV. Provider business mailing address

130 S MAIN ST
OWASSO OK
74055-3108
US

V. Phone/Fax

Practice location:
  • Phone: 918-274-1737
  • Fax: 918-274-1745
Mailing address:
  • Phone: 918-274-1737
  • Fax: 918-274-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number24520
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHY M CAMPBELL
Title or Position: OWNER CLINICAL CARE PHARMACY OF OWA
Credential: PHARMD
Phone: 918-274-1737