MEDICARE: HUNTERS GREEN COUNTRY PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	4-6511	OK
2	3336L0003X	Long Term Care Pharmacy	4-6511	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1285056846	OTHER		NPI
2	3727825	OTHER		NCPDP
3	4-6511	OTHER	OK	STATE LICENSE OK
4	47420	OTHER	OK	OBNDD - BUREAU OF NARCOTICS OK
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	2143834	OTHER		PK

General Provider Information

NPI Number	:	1285056846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTERS GREEN COUNTRY PHARMACY LLC

Provider Business Mailing Address
First Line	:	10120 BROADWAY EXT STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-6300
Country	:	US
Telephone Number	:	405-640-7545
Fax Number	:	405-418-2766

Provider Business Practice Location Address
First Line	:	110 W MARTIN LUTHER KING ST STE 2D
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-3351
Country	:	US
Telephone Number	:	918-913-3652
Fax Number	:	918-683-2185

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	HUNTER JOE HOGAN III
Credential	:	DPH
Telephone Number	:	405-418-2929

Provider Enumeration Date	:	01/15/2014
Last Update Date	:	01/27/2026

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Directions to “HUNTERS GREEN COUNTRY PHARMACY LLC ” Practice Location

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