Chickasha Clinic Pharmacy LLC
Organization Active NPI Community/Retail Pharmacy · Chickasha, OK
NPI 1114087350 · NPPES record last updated Jun 8, 2022
Key facts
- NPI
- 1114087350
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 18-5929 (OK)
- Legal business name
- CHICKASHA CLINIC PHARMACY LLC
- Practice address
- 2224 W Iowa Ave
Chickasha, OK 73018-2738 - Phone
- (405) 224-4851
- Fax
- (405) 222-9157
- NPI assigned
- Dec 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Julie Justice
- Title
- Authorized Agent
- Phone
- (405) 447-3911
Practitioners 1
-
Lisa Yokum, D.PH
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Chickasha Clinic Pharmacy, LLC |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130816000263 | OK | DME Supplier - Pharmacy | 6002061645 | Practice locations: Chickasha, OK |
National Provider Directory
Locations
2224 W Iowa Ave
Chickasha, OK 73018
Phone (405) 224-4851
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 18-5929 | OK | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
2224 W Iowa Ave
Chickasha, OK 73018-2738
Mailing address
2224 W Iowa Ave
Chickasha, OK 73018-2738
Phone (405) 224-4851
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100236490A | Medicaid | OK | |
| 2135238 | Other | PK |
Other names
- Chickasha Clinic Pharmacy, LLC
Other providers in Chickasha, OK
- Steven Wayne Chandler
- Aurelia Kate Chaney
- Bethanie Chaney
- Keely Chapman
- Chateau de South Corporation
- Chickasha Dental Group PLLC
- Chickasha Hearing Aid Center
- Chickasha Hospitalist Services PLLC
- Chickasha Nursing Center Inc.
- Chickasha Opportunity Center, Inc.
All providers in Chickasha, OK · Community/Retail Pharmacy in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.