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General NPI Number Information
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NPI Number | 1871823781
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Entity Type | Organization
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Legal Business Name | GLENPOOL PHARMACY INC
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 1601 N PEORIA AVE
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City | TULSA
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State | OK
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Zip | 74106-4463
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Country | US
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Telephone | 918-322-3667
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Fax | 918-322-3667
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Provider Business Mailing Address
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Address Line | PO BOX 887
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City | GLENPOOL
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State | OK
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Zip | 74033-0887
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Country | US
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Telephone | 918-322-3667
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Fax | 918-322-5923
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Authorized Official
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Title or Position | SPECIALIST, CUSTOMER OPS SUPPORT
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Name | MATTHEW MORGAN
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Credential |
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Telephone | 614-652-1509
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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 |
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License Number State |
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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 | 25496
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License Number State | OK
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