MEDICARE: YALE DRUG LTC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8-3618	OTHER	OK	OKLAHOMA STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1548904568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YALE DRUG LTC

Provider Business Mailing Address
First Line	:	121 N MAIN ST
Second Line	:
City	:	YALE
State	:	OK
Zip	:	74085-2507
Country	:	US
Telephone Number	:	918-387-4183
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 N MAIN ST
Second Line	:
City	:	YALE
State	:	OK
Zip	:	74085-2507
Country	:	US
Telephone Number	:	918-387-4183
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TROY SIMONS
Credential	:
Telephone Number	:	405-742-8099

Provider Enumeration Date	:	04/26/2022
Last Update Date	:	04/26/2022

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Directions to “YALE DRUG LTC ” Practice Location

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