=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023168051
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLAREMORE IHS PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 06/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 S MOORE AVE
-----------------------------------------------------
City | CLAREMORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74017-5047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-342-6581
-----------------------------------------------------
Fax | 918-342-6330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 95431
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44101-0033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-342-6200
-----------------------------------------------------
Fax | 918-342-6436
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AREA PHARMACY CONSULTANT
-----------------------------------------------------
Name | TRACIE PATTEN
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 405-951-6035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332800000X
-----------------------------------------------------
Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------