Healthcare Provider Details

I. General information

NPI: 1649336520
Provider Name (Legal Business Name): CHOTEAU DISCOUNT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N CHOUTEAU AVE
CHOUTEAU OK
74337-3242
US

IV. Provider business mailing address

PO BOX 700
INOLA OK
74036-0700
US

V. Phone/Fax

Practice location:
  • Phone: 918-476-6455
  • Fax: 918-476-6966
Mailing address:
  • Phone: 918-476-6455
  • Fax: 918-476-6966

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 Number30-4564
License Number StateOK

VIII. Authorized Official

Name: KAREN CHASE
Title or Position: OWNER
Credential:
Phone: 918-476-6455