Healthcare Provider Details

I. General information

NPI: 1982698585
Provider Name (Legal Business Name): T & L PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 NORTH HOY
BUFFALO OK
73834
US

IV. Provider business mailing address

1001 HWY 64 NORTH P.O.BOX 120
BUFFALO OK
73834-0120
US

V. Phone/Fax

Practice location:
  • Phone: 580-735-2161
  • Fax: 580-735-2230
Mailing address:
  • Phone: 580-735-2161
  • Fax: 580-735-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number713536
License Number StateOK

VIII. Authorized Official

Name: MRS. VERA LYNN ROBERTSON
Title or Position: PHARMACIST
Credential: DPH
Phone: 580-735-2161