Provider Demographics
NPI:1497842272
Name:HOOKER PHARMACY PLLC
Entity Type:Organization
Organization Name:HOOKER PHARMACY PLLC
Other - Org Name:BOISE CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:KENAN
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:DENTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:580-544-3441
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:BOISE CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73933-0097
Mailing Address - Country:US
Mailing Address - Phone:580-544-3441
Mailing Address - Fax:405-767-0905
Practice Address - Street 1:318 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOISE CITY
Practice Address - State:OK
Practice Address - Zip Code:73933-9607
Practice Address - Country:US
Practice Address - Phone:580-544-3441
Practice Address - Fax:405-767-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100238790BMedicaid
1821718859OtherNPI FOR PHARMACIST
OK100238790AMedicaid
2074124OtherPK
OK1173920001Medicare NSC