Healthcare Provider Details

I. General information

NPI: 1790777126
Provider Name (Legal Business Name): HUTTON PHARMACY #2 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E TONKAWA AVE
TONKAWA OK
74653-3511
US

IV. Provider business mailing address

PO BOX 506
TONKAWA OK
74653-0506
US

V. Phone/Fax

Practice location:
  • Phone: 580-628-3312
  • Fax: 580-628-3322
Mailing address:
  • Phone: 580-628-3312
  • Fax: 580-628-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number6 1966
License Number StateOK

VIII. Authorized Official

Name: MR. HAROLD R HUTTON II
Title or Position: PRESIDENT/OWNER
Credential: DPH
Phone: 580-628-3312