Healthcare Provider Details

I. General information

NPI: 1306910831
Provider Name (Legal Business Name): BRATTON DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S OKLAHOMA AVE
MANGUM OK
73554-4219
US

IV. Provider business mailing address

109 S OKLAHOMA AVE
MANGUM OK
73554-4219
US

V. Phone/Fax

Practice location:
  • Phone: 580-782-2195
  • Fax: 580-782-3485
Mailing address:
  • Phone: 580-782-2195
  • Fax: 580-782-3485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6068
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BLAKE BRATTON
Title or Position: PRESIDENT PHARMACIST
Credential:
Phone: 580-782-2195