Provider Demographics
NPI:1912447806
Name:CHRIS ISBELL PHARMACY LLC
Entity Type:Organization
Organization Name:CHRIS ISBELL PHARMACY LLC
Other - Org Name:JOHNNY'S HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ISBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-427-0400
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954-0408
Mailing Address - Country:US
Mailing Address - Phone:918-427-0400
Mailing Address - Fax:918-427-0401
Practice Address - Street 1:303 E RAY FINE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954-5360
Practice Address - Country:US
Practice Address - Phone:918-427-0400
Practice Address - Fax:918-427-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3478563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200699000AMedicaid
AR220467407Medicaid