Provider Demographics
NPI:1023042314
Name:HARRAH PHARMACY INC.
Entity Type:Organization
Organization Name:HARRAH PHARMACY INC.
Other - Org Name:HARRAH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-454-2476
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-0247
Mailing Address - Country:US
Mailing Address - Phone:405-454-2476
Mailing Address - Fax:405-454-3507
Practice Address - Street 1:2060 N CHURCH AVE
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-0247
Practice Address - Country:US
Practice Address - Phone:405-454-2476
Practice Address - Fax:405-454-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8116183500000X
TX37391835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition SupportGroup - Multi-Specialty