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General NPI Number Information
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NPI Number | 1285056846
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Entity Type | Organization
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Legal Business Name | HUNTERS GREEN COUNTRY PHARMACY LLC
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 110 W MARTIN LUTHER KING ST STE 2D
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City | MUSKOGEE
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State | OK
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Zip | 74401-3351
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Country | US
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Telephone | 918-913-3652
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Fax | 918-683-2185
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Provider Business Mailing Address
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Address Line | 10120 BROADWAY EXT STE 200
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City | OKLAHOMA CITY
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State | OK
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Zip | 73114-6300
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Country | US
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Telephone | 405-640-7545
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Fax | 405-418-2766
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | HUNTER JOE HOGAN III
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Credential | DPH
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Telephone | 405-418-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 4-6511
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 4-6511
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License Number State | OK
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