Healthcare Provider Details

I. General information

NPI: 1275072977
Provider Name (Legal Business Name): BINTZ PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 10/17/2018
Certification Date:
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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number6-5771
License Number StateOK

VIII. Authorized Official

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