Healthcare Provider Details

I. General information

NPI: 1811012354
Provider Name (Legal Business Name): BLANCHARD DRUG & GIFT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 N COUNCIL RD
BLANCHARD OK
73010-8000
US

IV. Provider business mailing address

PO BOX 786
BLANCHARD OK
73010-0786
US

V. Phone/Fax

Practice location:
  • Phone: 405-485-2112
  • Fax: 405-485-8661
Mailing address:
  • Phone: 405-485-2112
  • Fax: 405-485-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number47-3971
License Number StateOK

VIII. Authorized Official

Name: MRS. LISA RENEA STANDRIDGE
Title or Position: OWNER
Credential: PHARM D
Phone: 405-485-2112