Healthcare Provider Details

I. General information

NPI: 1437106911
Provider Name (Legal Business Name): MEDICAL CENTER PHARMACY OF DURANT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 E 24TH ST
TISHOMINGO OK
73460-3214
US

IV. Provider business mailing address

1026 RADIO RD
DURANT OK
74701-2991
US

V. Phone/Fax

Practice location:
  • Phone: 580-371-2727
  • Fax: 580-371-2370
Mailing address:
  • Phone: 580-924-2626
  • Fax: 580-924-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number61-S-793
License Number StateOK

VIII. Authorized Official

Name: MR. GREG W SEAY
Title or Position: PRESIDENT
Credential: DPH
Phone: 580-924-7425