Healthcare Provider Details

I. General information

NPI: 1407939457
Provider Name (Legal Business Name): OSBORN DRUGS NO 4
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 N 3RD
LANGLEY OK
74350
US

IV. Provider business mailing address

PO BOX 31
MIAMI OK
74355-0031
US

V. Phone/Fax

Practice location:
  • Phone: 918-542-4444
  • Fax:
Mailing address:
  • Phone: 918-542-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number303005
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM E OSBORN
Title or Position: OWNER
Credential: PHARMD
Phone: 918-542-4444