Provider Demographics
NPI:1609817840
Name:MEDICAL CENTER PHARMACY OF DURANT INC
Entity Type:Organization
Organization Name:MEDICAL CENTER PHARMACY OF DURANT INC
Other - Org Name:MEDICAL CENTER PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAY
Authorized Official - Suffix:
Authorized Official - Credentials:D PH
Authorized Official - Phone:580-924-7425
Mailing Address - Street 1:1026 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2991
Mailing Address - Country:US
Mailing Address - Phone:580-924-7425
Mailing Address - Fax:580-924-0525
Practice Address - Street 1:1026 RADIO RD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2991
Practice Address - Country:US
Practice Address - Phone:580-924-7425
Practice Address - Fax:580-924-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336H0001X, 3336L0003X
OK27-48463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2072728OtherPK
OK100234540AMedicaid
0935160001Medicare NSC