Provider Demographics
NPI:1003684556
Name:COMANCHE COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:COMANCHE COUNTY HOSPITAL AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:DPH, DOP
Authorized Official - Phone:580-585-5401
Mailing Address - Street 1:3401 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6332
Mailing Address - Country:US
Mailing Address - Phone:580-585-5436
Mailing Address - Fax:580-585-5455
Practice Address - Street 1:3201 W GORE BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6350
Practice Address - Country:US
Practice Address - Phone:580-585-5401
Practice Address - Fax:580-510-7033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMANCHE COUNTY HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100749570RMedicaid