Healthcare Provider Details

I. General information

NPI: 1316276637
Provider Name (Legal Business Name): YUKON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S MUSTANG RD
YUKON OK
73099-6737
US

IV. Provider business mailing address

520 S MUSTANG RD
YUKON OK
73099-6737
US

V. Phone/Fax

Practice location:
  • Phone: 405-256-6653
  • Fax: 405-256-6647
Mailing address:
  • Phone: 405-256-6653
  • Fax: 405-256-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number26-7775
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAD EMRY HESTON
Title or Position: OWNER / PHARMACIST-IN-CHARGE
Credential: PHARMD
Phone: 405-256-6653