Healthcare Provider Details

I. General information

NPI: 1396835013
Provider Name (Legal Business Name): HOLDER-SOUTHERN DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 BARNES AVE
ALVA OK
73717
US

IV. Provider business mailing address

513 BARNES AVE
ALVA OK
73717-2229
US

V. Phone/Fax

Practice location:
  • Phone: 580-327-3332
  • Fax: 580-327-1848
Mailing address:
  • Phone: 580-327-3332
  • Fax: 580-327-1848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50-2293
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number50-2293
License Number StateOK

VIII. Authorized Official

Name: JOHN TODD HOLDER
Title or Position: PRESIDENT
Credential:
Phone: 580-327-3332