Provider Demographics
NPI:1346017407
Name:HUNTER'S GRAND PHARMACY, LLC
Entity Type:Organization
Organization Name:HUNTER'S GRAND PHARMACY, LLC
Other - Org Name:HUNTER'S GRAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-640-7545
Mailing Address - Street 1:10120 BROADWAY EXT STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-6300
Mailing Address - Country:US
Mailing Address - Phone:405-640-7545
Mailing Address - Fax:405-418-2766
Practice Address - Street 1:6111 E SKELLY DR STE 1100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6100
Practice Address - Country:US
Practice Address - Phone:918-309-6774
Practice Address - Fax:918-309-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3732321OtherNCPDP
OK2-9595OtherOK STATE BOARD OF PHARMACY LICENSE