Provider Demographics
NPI:1952193245
Name:GUYMON CLINIC PHARMACY LLC
Entity type:Organization
Organization Name:GUYMON CLINIC PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DPH
Authorized Official - Prefix:
Authorized Official - First Name:CHET
Authorized Official - Middle Name:
Authorized Official - Last Name:OBLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-338-3339
Mailing Address - Street 1:PO BOX 1590
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-1590
Mailing Address - Country:US
Mailing Address - Phone:580-338-3339
Mailing Address - Fax:
Practice Address - Street 1:1210 N LELIA ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-3647
Practice Address - Country:US
Practice Address - Phone:580-338-3339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy