Provider Demographics
NPI:1790777126
Name:HUTTON PHARMACY #2 INC
Entity Type:Organization
Organization Name:HUTTON PHARMACY #2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUTTON
Authorized Official - Suffix:II
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-628-3312
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:TONKAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74653-0506
Mailing Address - Country:US
Mailing Address - Phone:580-628-3312
Mailing Address - Fax:580-628-3322
Practice Address - Street 1:205 E TONKAWA AVE
Practice Address - Street 2:
Practice Address - City:TONKAWA
Practice Address - State:OK
Practice Address - Zip Code:74653-3511
Practice Address - Country:US
Practice Address - Phone:580-628-3312
Practice Address - Fax:580-628-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6 1966333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0152540001Medicare ID - Type Unspecified