Provider Demographics
NPI:1710978937
Name:ANDERSON-BRITTON LLC
Entity Type:Organization
Organization Name:ANDERSON-BRITTON LLC
Other - Org Name:SPOONFUL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ANDERSON-CAROTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:405-282-0661
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044
Mailing Address - Country:US
Mailing Address - Phone:405-282-0661
Mailing Address - Fax:405-282-0631
Practice Address - Street 1:105 E. INDUSTRIAL
Practice Address - Street 2:SUITE B
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044
Practice Address - Country:US
Practice Address - Phone:405-282-0661
Practice Address - Fax:405-282-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3705108OtherNABP
OK3705108OtherNCPDP
OK100246130AMedicaid
OK4447610001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #