Healthcare Provider Details

I. General information

NPI: 1962721464
Provider Name (Legal Business Name): RX SHOPPE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 12/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S MAIN ST
GROVE OK
74344-2845
US

IV. Provider business mailing address

PO BOX 6598
GROVE OK
74344-6598
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-1092
  • Fax: 918-786-4642
Mailing address:
  • Phone: 918-786-1092
  • Fax: 918-786-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number45-7418
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TERESA BUTLER
Title or Position: PIC/PRESIDENT
Credential:
Phone: 918-786-1092