Provider Demographics
NPI:1871823781
Name:GLENPOOL PHARMACY INC
Entity Type:Organization
Organization Name:GLENPOOL PHARMACY INC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIALIST, CUSTOMER OPS SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-652-1509
Mailing Address - Street 1:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-0887
Mailing Address - Country:US
Mailing Address - Phone:918-322-3667
Mailing Address - Fax:918-322-5923
Practice Address - Street 1:1601 N PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-4463
Practice Address - Country:US
Practice Address - Phone:918-322-3667
Practice Address - Fax:918-322-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK254963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3726037OtherNCPDP PROVIDER IDENTIFICATION NUMBER