Provider Demographics
NPI:1891800264
Name:WEATHERFORD PHARMACY INC
Entity Type:Organization
Organization Name:WEATHERFORD PHARMACY INC
Other - Org Name:MORE THAN MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:580-772-2781
Mailing Address - Street 1:PO BOX 1967
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-1967
Mailing Address - Country:US
Mailing Address - Phone:580-772-2781
Mailing Address - Fax:580-772-2764
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-4939
Practice Address - Country:US
Practice Address - Phone:580-772-2781
Practice Address - Fax:580-772-2764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
OK2840503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK90003928728Medicaid
2073338OtherPK
OK100244360AMedicaid
OK100244360AMedicaid