Guymon Clinic Pharmacy LLC
Organization Active NPI Community/Retail Pharmacy · Guymon, OK
NPI 1508945486 · NPPES record last updated Aug 22, 2024
Key facts
- NPI
- 1508945486
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 435014 (OK)
- Legal business name
- GUYMON CLINIC PHARMACY LLC
- Practice address
- 1210 N Lelia St
Guymon, OK 73942-3647 - Phone
- (580) 338-3339
- Fax
- (580) 338-1010
- NPI assigned
- Nov 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Chet Oblander
- Title
- Partner
- Phone
- (580) 338-3339
Corporate family (same tax ID) 1
Practitioners 3
-
Adam Lance Fick, PHARMD
-
Chet Oblander, DOCTOR OF PHARMACY
-
Chelle Melton, DOCTOR OF PHARMACY
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170125000275 | OK | Part B Supplier - Mass Immunization (Roster Biller Only) | 2163704214 | Practice locations: Guymon, OK |
National Provider Directory
- Tax ID family
- Clinic Pharmacy
Locations
1210 N Lelia St
Guymon, OK 73942
Phone (580) 338-3339
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 435014 | OK | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
1210 N Lelia St
Guymon, OK 73942-3647
Mailing address
PO Box 1590
Guymon, OK 73942-1590
Phone (580) 338-3339
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2081576 | Other | PK | |
| 100241140A | Medicaid | OK |
Other names
- CLINIC PHARMACY
Other providers in Guymon, OK
- Julia Gonzales
- Fabian Gonzalez
- Grand Lake Mental Health Center, Inc.
- Gilbert G Gutierrez
- Guymon Anesthesia Management Services, LLC
- Guymon Clinic Pharmacy LLC
- Guymon Emergency Medicine PLLC
- Guymon Physical Therapy and Wellness PLLC
- Guymon Public Schools
- Guymon Surgical Consultants LLC
All providers in Guymon, 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 22, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.