Provider Demographics
NPI:1073091070
Name:BRODERICK ENTERPRISES, LLC
Entity Type:Organization
Organization Name:BRODERICK ENTERPRISES, LLC
Other - Org Name:MCCORTNEY'S FAMILY PHARMACY & COMPOUNDING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWER
Authorized Official - Prefix:
Authorized Official - First Name:ZACK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:580-332-3344
Mailing Address - Street 1:711 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-3807
Mailing Address - Country:US
Mailing Address - Phone:580-332-3344
Mailing Address - Fax:580-332-3616
Practice Address - Street 1:711 E 9TH ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3807
Practice Address - Country:US
Practice Address - Phone:580-332-3344
Practice Address - Fax:580-332-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23-82283336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy