=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316097389
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANADARKO IHS PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 08/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 NE OLD TOWN RD
-----------------------------------------------------
City | ANADARKO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-247-7947
-----------------------------------------------------
Fax | 405-247-7052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 OLD TOWN NE
-----------------------------------------------------
City | ANADARKO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCA PHARMACY CONSULTANT
-----------------------------------------------------
Name | KAILEEN SKIDEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-762-6611
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------