Provider Demographics
NPI:1750475166
Name:ARDMORE FAMILY PHARMACY
Entity Type:Organization
Organization Name:ARDMORE FAMILY PHARMACY
Other - Org Name:REED FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:416-825-4430
Mailing Address - Street 1:814 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-4527
Mailing Address - Country:US
Mailing Address - Phone:580-223-7636
Mailing Address - Fax:580-223-0320
Practice Address - Street 1:814 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-4527
Practice Address - Country:US
Practice Address - Phone:580-223-7636
Practice Address - Fax:580-223-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
OK1234703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3717533OtherNCPDP
OK90003923950Medicaid
OK12-5354OtherOK STATE BOARD
3717533OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OKB5702OtherMASS IMMUNIZATION ROSTER BILLER
OK12-5354OtherOK STATE BOARD
3717533OtherNCPDP
3717533OtherNCPDP