Healthcare Provider Details

I. General information

NPI: 1568555902
Provider Name (Legal Business Name): TABORS DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S MAIN ST
LINDSAY OK
73052-5633
US

IV. Provider business mailing address

225 S MAIN ST
LINDSAY OK
73052-5633
US

V. Phone/Fax

Practice location:
  • Phone: 405-756-4511
  • Fax: 405-756-2861
Mailing address:
  • Phone: 405-756-4511
  • Fax: 405-756-2861

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number22-871
License Number StateOK

VIII. Authorized Official

Name: KALYN TABOR
Title or Position: OWNER
Credential:
Phone: 705-756-4511