MEDICARE: CLIFS 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
2	3336C0003X	Community/Retail Pharmacy	344186	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2076064	OTHER		PK

General Provider Information

NPI Number	:	1578563060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIFS PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 1700
Second Line	:
City	:	SALLISAW
State	:	OK
Zip	:	74955-1700
Country	:	US
Telephone Number	:	918-776-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 E REDWOOD AVE
Second Line	:
City	:	SALLISAW
State	:	OK
Zip	:	74955-3020
Country	:	US
Telephone Number	:	918-776-0100
Fax Number	:	918-775-4749

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL MEECE
Credential	:
Telephone Number	:	918-776-0100

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	08/23/2020

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Directions to “CLIFS PHARMACY LLC ” Practice Location

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