Healthcare Provider Details

I. General information

NPI: 1467585653
Provider Name (Legal Business Name): ELLIOTT PLAZA PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S ELLIOTT ST
PRYOR OK
74361-6411
US

IV. Provider business mailing address

510 S ELLIOTT ST
PRYOR OK
74361-6411
US

V. Phone/Fax

Practice location:
  • Phone: 918-825-2225
  • Fax: 918-825-0972
Mailing address:
  • Phone: 918-825-2225
  • Fax: 918-825-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number30-4970
License Number StateOK

VIII. Authorized Official

Name: PAUL ANDREW TURNER
Title or Position: MEMBER
Credential:
Phone: 918-543-8777