Provider Demographics
NPI:1255430781
Name:HINTON RX INC.
Entity type:Organization
Organization Name:HINTON RX INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-542-6222
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73047-0578
Mailing Address - Country:US
Mailing Address - Phone:405-542-6222
Mailing Address - Fax:405-542-6226
Practice Address - Street 1:407 N BROADWAY
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:OK
Practice Address - Zip Code:73047
Practice Address - Country:US
Practice Address - Phone:405-542-6222
Practice Address - Fax:405-542-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336L0003X
OK2050963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100244700AMedicaid
OK0805780001Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID