Healthcare Provider Details

I. General information

NPI: 1649193897
Provider Name (Legal Business Name): HIGHWAY 81 PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MAIN ST
WAURIKA OK
73573-3053
US

IV. Provider business mailing address

101 S MAIN ST
WAURIKA OK
73573-3053
US

V. Phone/Fax

Practice location:
  • Phone: 580-228-2383
  • Fax: 580-228-3290
Mailing address:
  • Phone: 580-228-2383
  • Fax: 580-228-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOEL DAVENPORT
Title or Position: OWNER
Credential: PHARM.D.
Phone: 580-228-2383