Provider Demographics
NPI:1285653337
Name:DEER CREEK PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:DEER CREEK PHARMACY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:BARNEY
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-663-4111
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:HYDRO
Mailing Address - State:OK
Mailing Address - Zip Code:73048
Mailing Address - Country:US
Mailing Address - Phone:405-663-4111
Mailing Address - Fax:405-663-4114
Practice Address - Street 1:509 ARAPAHO ST
Practice Address - Street 2:
Practice Address - City:HYDRO
Practice Address - State:OK
Practice Address - Zip Code:73048
Practice Address - Country:US
Practice Address - Phone:405-663-4111
Practice Address - Fax:405-663-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site