| NPI | 1215001748 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY WOODSON Owner 580-355-3164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 333600000X Pharmacy (Licence: OK 34445) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |