Provider Demographics
NPI:1578663357
Name:H & G DISCOUNT PHARMACY LLC
Entity Type:Organization
Organization Name:H & G DISCOUNT PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-333-4848
Mailing Address - Street 1:112 NE WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-1634
Mailing Address - Country:US
Mailing Address - Phone:918-333-4848
Mailing Address - Fax:918-333-8948
Practice Address - Street 1:112 NE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-1650
Practice Address - Country:US
Practice Address - Phone:918-333-4848
Practice Address - Fax:918-333-8948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100812150AMedicaid
OK1206420001Medicare ID - Type Unspecified