Provider Demographics
NPI:1063853778
Name:LIMESTONE PHARMACY P.L.L.C.
Entity Type:Organization
Organization Name:LIMESTONE PHARMACY P.L.L.C.
Other - Org Name:LIMESTONE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLERY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:918-331-0000
Mailing Address - Street 1:3803 NOWATA RD STE C
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-5121
Mailing Address - Country:US
Mailing Address - Phone:918-331-0000
Mailing Address - Fax:918-331-9068
Practice Address - Street 1:3803 NOWATA RD STE C
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-5121
Practice Address - Country:US
Practice Address - Phone:918-331-0000
Practice Address - Fax:918-331-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK9-63123336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141180OtherPK
OK200507180AMedicaid