=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063853778
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIMESTONE PHARMACY P.L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2013
-----------------------------------------------------
Last Update Date | 11/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3803 NOWATA RD STE C
-----------------------------------------------------
City | BARTLESVILLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74006-5121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-331-0000
-----------------------------------------------------
Fax | 918-331-9068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3803 NOWATA RD STE C
-----------------------------------------------------
City | BARTLESVILLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74006-5121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-331-0000
-----------------------------------------------------
Fax | 918-331-9068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARMACIST
-----------------------------------------------------
Name | JACQUELINE GALLERY
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 918-331-0000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 9-6312
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------