Provider Demographics
NPI:1790182723
Name:KRITTENBRINK PHARMACY LLC
Entity Type:Organization
Organization Name:KRITTENBRINK PHARMACY LLC
Other - Org Name:KRITTENBRINK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:SCHIEBER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:405-263-4433
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:OKARCHE
Mailing Address - State:OK
Mailing Address - Zip Code:73762-0405
Mailing Address - Country:US
Mailing Address - Phone:405-263-4433
Mailing Address - Fax:405-263-4535
Practice Address - Street 1:315 KANSAS AVE
Practice Address - Street 2:
Practice Address - City:OKARCHE
Practice Address - State:OK
Practice Address - Zip Code:73762-0405
Practice Address - Country:US
Practice Address - Phone:405-263-4433
Practice Address - Fax:405-263-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54-68773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200564340AMedicaid
2148920OtherPK