| NPI | 1598766263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA L WELLS Store Manager 918-492-4242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: OK 24513) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: OK 24513) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2010-10-15 |