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General NPI Number Information
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NPI Number | 1295241867
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Entity Type | Organization
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Legal Business Name | MANNFORD PHARMACY LLC
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 231 W TROWER BLVD
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City | MANNFORD
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State | OK
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Zip | 74044
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Country | US
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Telephone | 918-865-7400
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Fax | 918-865-7411
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Provider Business Mailing Address
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Address Line | PO BOX 267
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City | MANNFORD
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State | OK
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Zip | 74044-0267
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Country | US
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Telephone | 918-865-7400
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Fax | 918-865-7411
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Authorized Official
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Title or Position | PIC/OWNER
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Name | KIMBERLY JOANNA TILLEY
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Credential | DPH
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Telephone | 918-865-7400
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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 | 11-8083
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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