Provider Demographics
NPI:1194808568
Name:CARTER KEENER & THURMAN INC
Entity type:Organization
Organization Name:CARTER KEENER & THURMAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:NEWTON
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:580-223-3000
Mailing Address - Street 1:PO BOX 1296
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-1296
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:907 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-4346
Practice Address - Country:US
Practice Address - Phone:580-223-3000
Practice Address - Fax:580-223-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
OK1244583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100238230AMedicaid
2073942OtherPK
2073942OtherPK