Provider Demographics
NPI:1790889038
Name:NORTHERN OKLAHOMA RESOURCE CENTER OF ENID PHARMACY
Entity Type:Organization
Organization Name:NORTHERN OKLAHOMA RESOURCE CENTER OF ENID PHARMACY
Other - Org Name:NORCE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:YVONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-237-1027
Mailing Address - Street 1:2600 E WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-8715
Mailing Address - Country:US
Mailing Address - Phone:580-237-1027
Mailing Address - Fax:580-548-2652
Practice Address - Street 1:2600 E WILLOW RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-8715
Practice Address - Country:US
Practice Address - Phone:580-237-1027
Practice Address - Fax:580-548-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK537583336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100769320BMedicaid
2076417OtherPK