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General NPI Number Information
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NPI Number | 1538408216
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Entity Type | Organization
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Legal Business Name | FAIRFAX MEDICAL FACILITIES, INC.
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 716 S HIGHWAY 77 A
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City | NEWKIRK
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State | OK
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Zip | 74647-7009
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Country | US
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Telephone | 580-362-2555
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Fax | 580-362-2948
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Provider Business Mailing Address
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Address Line | 212 N MAIN ST
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City | FAIRFAX
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State | OK
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Zip | 74637-3023
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Country | US
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Telephone | 580-362-2556
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Fax | 580-362-3165
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Authorized Official
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Title or Position | CEO
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Name | KAREN MCCONNELL
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Credential |
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Telephone | 918-642-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 9399
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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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