Provider Demographics
NPI:1417661760
Name:412 FAMILY PHARMACY, LLC
Entity Type:Organization
Organization Name:412 FAMILY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-543-8777
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:INOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74036-0700
Mailing Address - Country:US
Mailing Address - Phone:918-543-8777
Mailing Address - Fax:918-543-2013
Practice Address - Street 1:412 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:OK
Practice Address - Zip Code:74352-5117
Practice Address - Country:US
Practice Address - Phone:918-479-5223
Practice Address - Fax:918-479-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy