Healthcare Provider Details

I. General information

NPI: 1265592158
Provider Name (Legal Business Name): POPKESS PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 E DON TYLER AVE
DEWEY OK
74029-2518
US

IV. Provider business mailing address

524 E DON TYLER AVE
DEWEY OK
74029-2518
US

V. Phone/Fax

Practice location:
  • Phone: 918-534-2262
  • Fax: 918-534-3208
Mailing address:
  • Phone: 918-534-2262
  • Fax: 918-534-3208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY TAYLOR CLARK
Title or Position: OWNER
Credential: PHARMD
Phone: 918-534-2262