Provider Demographics
NPI:1073727517
Name:OLTON PHARMACY
Entity Type:Organization
Organization Name:OLTON PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JARROD
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-285-3044
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:522 8TH ST
Mailing Address - City:OLTON
Mailing Address - State:TX
Mailing Address - Zip Code:79064-1053
Mailing Address - Country:US
Mailing Address - Phone:806-285-3044
Mailing Address - Fax:806-285-2390
Practice Address - Street 1:522 8TH ST
Practice Address - Street 2:
Practice Address - City:OLTON
Practice Address - State:TX
Practice Address - Zip Code:79064-1053
Practice Address - Country:US
Practice Address - Phone:806-285-3044
Practice Address - Fax:806-285-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy