Healthcare Provider Details

I. General information

NPI: 1356348478
Provider Name (Legal Business Name): CENTRAL DRUG STORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 NORTH MAIN ST.
CEMENT OK
73017-0300
US

IV. Provider business mailing address

PO BOX 300
CEMENT OK
73017-0300
US

V. Phone/Fax

Practice location:
  • Phone: 405-489-3521
  • Fax: 405-489-3521
Mailing address:
  • Phone: 405-489-3521
  • Fax: 405-489-3521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20-2778
License Number StateOK

VIII. Authorized Official

Name: MR. MONTE EUGENE SNIDER
Title or Position: CHIEF PHARMACIST/MANAGER
Credential: DPH
Phone: 405-489-3521