Healthcare Provider Details

I. General information

NPI: 1760687545
Provider Name (Legal Business Name): OSBORN DRUGS NO 4 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 N THIRD STREET
LANGLEY OK
74350
US

IV. Provider business mailing address

PO BOX 609
LANGLEY OK
74350-0609
US

V. Phone/Fax

Practice location:
  • Phone: 918-782-3271
  • Fax: 918-782-9091
Mailing address:
  • Phone:
  • Fax:

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 Number30-7366
License Number StateOK

VIII. Authorized Official

Name: WILLIAM OSBORN
Title or Position: PRESIDENT
Credential:
Phone: 918-542-4444