Provider Demographics
NPI:1659451953
Name:PHARM BLANCHARD ACQUISITION LLC
Entity Type:Organization
Organization Name:PHARM BLANCHARD ACQUISITION LLC
Other - Org Name:RED CROSS DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-261-3048
Mailing Address - Street 1:PO BOX 2090
Mailing Address - Street 2:301 NE 10TH STREET
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-2090
Mailing Address - Country:US
Mailing Address - Phone:405-485-9311
Mailing Address - Fax:405-485-9312
Practice Address - Street 1:301 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-9817
Practice Address - Country:US
Practice Address - Phone:405-485-9311
Practice Address - Fax:405-485-9312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47-73193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153960OtherPK
OK200003480AMedicaid