Provider Demographics
NPI:1861669640
Name:STIGLER HEALTH AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:STIGLER HEALTH AND WELLNESS CENTER INC
Other - Org Name:HOOVER DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EFTON
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-967-8321
Mailing Address - Street 1:1505 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-2913
Mailing Address - Country:US
Mailing Address - Phone:918-967-8321
Mailing Address - Fax:918-967-4469
Practice Address - Street 1:1505 E MAIN ST UNIT C
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2914
Practice Address - Country:US
Practice Address - Phone:918-967-8321
Practice Address - Fax:918-967-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
OK58-66263336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200054500DMedicaid
2077202OtherPK
0155300001Medicare NSC