Healthcare Provider Details

I. General information

NPI: 1740808625
Provider Name (Legal Business Name): BIGBOX PHARMACY UNLIMITED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 E CHESTNUT ST STE B
HOLLIS OK
73550-2031
US

IV. Provider business mailing address

509 E CHESTNUT ST STE B
HOLLIS OK
73550-2031
US

V. Phone/Fax

Practice location:
  • Phone: 580-688-2257
  • Fax: 580-688-2288
Mailing address:
  • Phone: 580-688-2257
  • Fax: 580-688-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JUSTYN WILLIAMS
Title or Position: MANAGER
Credential:
Phone: 580-954-5454