Healthcare Provider Details

I. General information

NPI: 1841255379
Provider Name (Legal Business Name): BINTZ PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N 14TH ST
PONCA CITY OK
74601-1738
US

IV. Provider business mailing address

2701 N 14TH ST
PONCA CITY OK
74601-1738
US

V. Phone/Fax

Practice location:
  • Phone: 580-765-3055
  • Fax: 580-765-3410
Mailing address:
  • Phone: 580-765-3055
  • Fax: 580-765-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6-5771
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MATT BINTZ
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 580-765-3055