Provider Demographics
NPI:1548924020
Name:CLAREMORE COMPOUNDING CENTER INC
Entity type:Organization
Organization Name:CLAREMORE COMPOUNDING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGHTOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-754-1090
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74362
Mailing Address - Country:US
Mailing Address - Phone:405-754-1090
Mailing Address - Fax:405-594-6007
Practice Address - Street 1:1000 W WILSHIRE BLVD SUITE 401
Practice Address - Street 2:
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:405-754-1090
Practice Address - Fax:405-594-6007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAREMORE COMPOUNDING CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEAOtherFCO847220