Last Updated:  12/22/2024 5:22:09 AM

Pharmacy Detail                               

Corporation / Company Owner Name

WAGONER HOSPITAL AUTHORITY 

Business (DBA) Name  

WAGONER COMMUNITY HOSPITAL 

License Number 

38-5113 

Type of Pharmacy

Hospital 

Address

1200 W CHEROKEE

City, State, Zip 

WAGONER, OK  74467-4624

Country 

 

Issue Date 

08/23/2006 

Renewed Date

07/18/2024

Expiration Date 

08/31/2025 

End Date 

 

Replacing

38-4327

Replaced By

Drug Supplier

No 

Sterile Compounding

No 

Training Area

No 

Unused Drug Dispensing

No 

LTC Emergency Kit

No

Pharmacist-In-Charge

JEREMY MICHAEL LANDSAW - 15773

Status

License in Good Standing 

In Process?

 

Disciplinary Action
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Case Date  

Case Number  

No Disciplinary Action 

 

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