Provider Demographics
NPI:1194072363
Name:HUGHES PHARMACY LLC
Entity type:Organization
Organization Name:HUGHES PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/AO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-395-3116
Mailing Address - Street 1:107 E CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73759-1209
Mailing Address - Country:US
Mailing Address - Phone:580-395-3116
Mailing Address - Fax:580-395-3125
Practice Address - Street 1:107 E CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OK
Practice Address - Zip Code:73759-1209
Practice Address - Country:US
Practice Address - Phone:580-395-3116
Practice Address - Fax:580-395-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK6460193336C0003X
OK64-79843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136363OtherPK
OK200447840AMedicaid