37D2186087 CLIA NUMBER - PRUETT'S FOOD-PHARMACY #1

Laboratory Demographics

CLIA Number: 37D2186087

Facility Name: PRUETT'S FOOD-PHARMACY #1

Facility Address:
201 S PARK DR
BROKEN BOW, OK
ZIP 74728
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Facility Phone Number: 580 236-2056

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1558881623

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	37D2186087
LAB Type	Pharmacy
Facility Name	PRUETT'S FOOD-PHARMACY #1
Street	201 S PARK DR
City	BROKEN BOW
State	OK
ZIP	74728
Phone	580 236-2056
CertificateType	4
CertificateEffectiveDate	6/15/2022
CertificateExpirationDate	6/14/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024