Healthcare Provider Details

I. General information

NPI: 1508882143
Provider Name (Legal Business Name): GADDY DISCOUNT DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 W BROADWAY ST
MUSKOGEE OK
74401-6246
US

IV. Provider business mailing address

1126 W BROADWAY ST
MUSKOGEE OK
74401-6246
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-5584
  • Fax: 918-682-5585
Mailing address:
  • Phone: 918-682-5584
  • Fax: 918-682-5585

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 Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4-5023
License Number StateOK

VIII. Authorized Official

Name: ROBERT AUSTIN YATES
Title or Position: PRESIDENT
Credential:
Phone: 918-682-5584