Healthcare Provider Details

I. General information

NPI: 1487088175
Provider Name (Legal Business Name): PHARMCAREOK OF DURANT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WALDRON DR
DURANT OK
74701-1902
US

IV. Provider business mailing address

PO BOX 130
HYDRO OK
73048-0130
US

V. Phone/Fax

Practice location:
  • Phone: 580-920-2211
  • Fax: 580-920-2215
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number276104
License Number StateOK

VIII. Authorized Official

Name: KENT ABBOTT
Title or Position: PRESIDENT
Credential:
Phone: 405-663-4111