Provider Demographics
NPI:1841255379
Name:BINTZ PHARMACY, INC.
Entity type:Organization
Organization Name:BINTZ PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:BINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-765-3055
Mailing Address - Street 1:2701 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1738
Mailing Address - Country:US
Mailing Address - Phone:580-765-3055
Mailing Address - Fax:580-765-3410
Practice Address - Street 1:2701 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1738
Practice Address - Country:US
Practice Address - Phone:580-765-3055
Practice Address - Fax:580-765-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336L0003X
OK6-57713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100233080CMedicaid
OK100233080AMedicaid
2127193OtherPK
OK100233080CMedicaid