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General NPI Number Information
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NPI Number | 1427841360
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Entity Type | Organization
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Legal Business Name | EASTSIDE CLINIC PHARMACY
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 3612 SE LEE BLVD
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City | LAWTON
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State | OK
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Zip | 73501-8451
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Country | US
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Telephone | 580-355-6400
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Fax | 580-355-0451
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Provider Business Mailing Address
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Address Line | 3612 SE LEE BLVD
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City | LAWTON
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State | OK
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Zip | 73501-8451
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Country | US
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Telephone | 580-355-6400
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Fax |
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Authorized Official
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Title or Position | PIC/OWNER
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Name | JESSE WILSON
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Credential | PHARMD
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Telephone | 580-355-6400
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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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