Provider Demographics
NPI:1396580676
Name:COLLINSVILLE FAMILY PHARMACY LC
Entity type:Organization
Organization Name:COLLINSVILLE FAMILY PHARMACY LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLTON
Authorized Official - Middle Name:B
Authorized Official - Last Name:TURNBULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-371-2547
Mailing Address - Street 1:1205 W MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-3114
Mailing Address - Country:US
Mailing Address - Phone:918-371-2547
Mailing Address - Fax:918-371-0268
Practice Address - Street 1:1205 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-3114
Practice Address - Country:US
Practice Address - Phone:918-371-2547
Practice Address - Fax:918-371-0268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLLINSVILLE FAMILY PHARMACY LC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy