Provider Demographics
NPI:1366463432
Name:GFJ INC
Entity Type:Organization
Organization Name:GFJ INC
Other - Org Name:BROKEN ARROW FAMILY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDERGRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:918-451-3784
Mailing Address - Street 1:3359 S ELM PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7924
Mailing Address - Country:US
Mailing Address - Phone:918-451-3784
Mailing Address - Fax:918-451-2295
Practice Address - Street 1:3359 S ELM PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7924
Practice Address - Country:US
Practice Address - Phone:918-451-3784
Practice Address - Fax:918-451-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
OK253443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2076303OtherPK
OK100812690BMedicaid
2076303OtherPK
OK100812690AMedicaid
OK1304780001Medicare NSC