Provider Demographics
NPI:1477646818
Name:JOHN HARDY FAMILY ENTERPRISES LLC
Entity Type:Organization
Organization Name:JOHN HARDY FAMILY ENTERPRISES LLC
Other - Org Name:WOODS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DPH
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-423-4333
Mailing Address - Street 1:200A S 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5447
Mailing Address - Country:US
Mailing Address - Phone:918-423-4333
Mailing Address - Fax:918-429-0498
Practice Address - Street 1:200A S 3RD STREET
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5447
Practice Address - Country:US
Practice Address - Phone:918-423-4333
Practice Address - Fax:918-429-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
OK15-61823336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100243470BMedicaid
OK100243470AMedicaid
2072960OtherPK