Last Updated: 12/6/2025 5:24:43 AM
Pharmacy
Detail
|
Corporation / Company Owner Name |
|
|
Business (DBA) Name |
KICKAPOO/IHS HEALTH CENTER |
|
License Number |
31-4250 |
|
Type of Pharmacy |
Retail |
|
Address |
105365 S HWY 102 BLDG M PO BOX 1059 |
|
City, State, Zip |
MCLOUD,
OK 74851-1059 |
|
Country |
|
|
Issue Date |
01/27/1998 |
|
Renewed Date |
12/05/2025 |
|
Expiration Date |
01/31/2027 |
|
End Date |
|
|
Replacing |
|
|
Replaced By |
|
|
Drug Supplier |
Yes |
|
Sterile Compounding |
No |
|
Training Area |
Yes |
|
Unused Drug Dispensing |
No |
|
LTC Emergency Kit |
No |
|
Pharmacist-In-Charge |
BRIAN DUBALA - 14489 |
|
Status |
License in Good Standing |
|
In Process? |
|
|
|
|
|
|
|
Disciplinary Action
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that column.
|
No Disciplinary
Action |
|
 
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- PRIMARY SOURCE VERIFICATION: The Oklahoma State Board of Pharmacy certifies that it maintains the information for the license verification function of this website, performs daily updates to the website and considers the website to be a secure, primary source for license verification.
- ATTENTION NEW REGISTRANTS! Website verification is not an official certificate of registration. You cannot practice in Oklahoma until you have received a letter of registration, renewal or permit from the Board
- WRITTEN VERIFICATION OF LICENSURE (OR LETTER OF GOOD STANDING): There is a $10 fee for a certified verification of license from the Board. Website verification remains free.