Provider Demographics
NPI:1598204877
Name:MCLOUD PHARMACY INC
Entity Type:Organization
Organization Name:MCLOUD PHARMACY INC
Other - Org Name:MCLOUD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-542-4444
Mailing Address - Street 1:704 S 8TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-8633
Mailing Address - Country:US
Mailing Address - Phone:405-964-3956
Mailing Address - Fax:405-964-3959
Practice Address - Street 1:704 S 8TH ST
Practice Address - Street 2:STE B
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-8633
Practice Address - Country:US
Practice Address - Phone:405-964-3956
Practice Address - Fax:405-964-3959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336L0003X
OK10-7799333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167460OtherPK
OK200695020AMedicaid
OK200695020BMedicaid