Provider Demographics
NPI:1316214026
Name:KATHY'S PHARMACY & GIFTS
Entity Type:Organization
Organization Name:KATHY'S PHARMACY & GIFTS
Other - Org Name:KATHY'S PHARMACY & GIFTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-267-4890
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:BEGGS
Mailing Address - State:OK
Mailing Address - Zip Code:74421-0217
Mailing Address - Country:US
Mailing Address - Phone:918-267-4890
Mailing Address - Fax:918-267-4061
Practice Address - Street 1:8054 HIGHWAY 16 STE 100
Practice Address - Street 2:
Practice Address - City:BEGGS
Practice Address - State:OK
Practice Address - Zip Code:74421-3126
Practice Address - Country:US
Practice Address - Phone:918-267-4890
Practice Address - Fax:918-267-4061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1450213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3726758OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OK200407990AMedicaid