Healthcare Provider Details

I. General information

NPI: 1952483752
Provider Name (Legal Business Name): UNITED DISCOUNT DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E BROADWAY ST
ALTUS OK
73521-5512
US

IV. Provider business mailing address

601 E BROADWAY ST
ALTUS OK
73521-5512
US

V. Phone/Fax

Practice location:
  • Phone: 580-477-0800
  • Fax: 580-477-0802
Mailing address:
  • Phone: 580-477-0800
  • Fax: 580-477-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number176355
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TERRA BROOKS
Title or Position: PHARMACY MANAGER
Credential:
Phone: 580-477-0800