| NPI | 1326739749 |
|---|---|
| Doing Business As | SALLISAW PHARMACY |
| Entity Type | Organization |
| Authorized Contact | DAKOTA RUSSELL TANNER Managing Member 918-775-4451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336L0003X Pharmacy, Long Term Care Pharmacy | |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2023-08-01 |