Provider Demographics
NPI:1891870184
Name:CEDAR SPRINGS PHARMACY INC
Entity Type:Organization
Organization Name:CEDAR SPRINGS PHARMACY INC
Other - Org Name:CEDAR SPRINGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:HINDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-381-4425
Mailing Address - Street 1:5310 E HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-8578
Mailing Address - Country:US
Mailing Address - Phone:405-381-4425
Mailing Address - Fax:405-381-4426
Practice Address - Street 1:5310 E HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-8578
Practice Address - Country:US
Practice Address - Phone:405-381-4425
Practice Address - Fax:405-381-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK18-26723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2073923OtherPK
OK100238340AMedicaid