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General NPI Number Information
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NPI Number | 1174827273
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Entity Type | Organization
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Legal Business Name | KINGFISHER PHARMACY MANAGEMENT PLLC
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 119 W ADMIRE AVE
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City | KINGFISHER
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State | OK
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Zip | 73750-2609
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Country | US
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Telephone | 405-375-3202
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Fax | 405-375-6739
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Provider Business Mailing Address
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Address Line | 119 W ADMIRE AVE
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City | KINGFISHER
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State | OK
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Zip | 73750-2609
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Country | US
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Telephone | 405-375-3202
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Fax | 405-375-6739
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | GREGORY HUENERGARDT
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Credential |
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Telephone | 580-938-2854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 54-5617
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License Number State | OK
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