Provider Demographics
NPI:1558735654
Name:HUNTER'S SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:HUNTER'S SPECIALTY PHARMACY LLC
Other - Org Name:SPECIATLY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY 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., SUITE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-749-0600
Mailing Address - Fax:405-749-0799
Practice Address - Street 1:10120 BROADWAY EXT., SUITE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114
Practice Address - Country:US
Practice Address - Phone:405-418-2929
Practice Address - Fax:405-749-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X
OK1-7404333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKBH8958805OtherDEA
OK200039880-BMedicaid
OK32493OtherOBNDD - BUREAU OF NARCOTICS OK
MO600011788Medicaid
OKOKB5983OtherMEDICARE ID MASS IMMUNIZER
OKOKB5983OtherMEDICARE ID MASS IMMUNIZER
OKOKB5983OtherMEDICARE ID MASS IMMUNIZER
OK200039880-BMedicaid