Healthcare Provider Details

I. General information

NPI: 1710018015
Provider Name (Legal Business Name): THRIFTY PHARMACY III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S SANTA FE AVE
EDMOND OK
73003-4766
US

IV. Provider business mailing address

230 S SANTA FE AVE
EDMOND OK
73003-4766
US

V. Phone/Fax

Practice location:
  • Phone: 405-715-4405
  • Fax: 405-715-4407
Mailing address:
  • Phone: 405-715-4405
  • Fax: 405-715-4407

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 Number1-5822
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DANI LYNCH COLSTON
Title or Position: PRES
Credential: DPH
Phone: 405-751-2852