Kingfisher Pharmacy Management PLLC
Organization Active NPI Community/Retail Pharmacy · Kingfisher, OK
NPI 1174827273 · NPPES record last updated Aug 18, 2026
Key facts
- NPI
- 1174827273
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 54-5617 (OK)
- Legal business name
- KINGFISHER PHARMACY MANAGEMENT PLLC
- Practice address
- 119 W Admire Ave
Kingfisher, OK 73750-2609 - Phone
- (405) 375-3202
- Fax
- (405) 375-6739
- NPI assigned
- Jan 4, 2011
- Organization subpart
- No
Authorized official
- Name
- Gregory Huenergardt
- Title
- Member Manager
- Phone
- (580) 938-2854
Practitioners 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D2186389 | Medic Pharmacy and Gifts | Certificate of waiver | Jun 15, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171011003758 | OK | Part B Supplier - Mass Immunization (Roster Biller Only) | 0042585366 | Practice locations: Kingfisher, OK |
| O20201223000855 | OK | Part B Supplier - Independent Clinical Laboratory | 0042585366 | Practice locations: Kingfisher, OK |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 54-5617 | OK | Yes |
| Compounding Pharmacy | 3336C0004X | |||
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
119 W Admire Ave
Kingfisher, OK 73750-2609
Mailing address
119 W Admire Ave
Kingfisher, OK 73750-2627
Phone (405) 375-3202
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200323020A | Medicaid | OK | |
| 2128250 | Other | PK |
Other names
- Medic Pharmacy and Gifts
Other providers in Kingfisher, OK
- Kingfisher Clinic PLLC
- Kingfisher Dental PLLC
- Kingfisher Dental PLLC
- Kingfisher Eye Clinic Inc
- Kingfisher Family Eyecare
- Kingfisher Public School
- Kingfisher Regional Hospital
- Kingfisher Regional Hospital
- Chasity Kirkman
- Cynthia Knapski
All providers in Kingfisher, 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 Aug 18, 2026. 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.