Healthcare Provider Details

I. General information

NPI: 1235688060
Provider Name (Legal Business Name): MUSTANG DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E STATE HIGHWAY 152
MUSTANG OK
73064-4406
US

IV. Provider business mailing address

103 E STATE HIGHWAY 152
MUSTANG OK
73064-4406
US

V. Phone/Fax

Practice location:
  • Phone: 405-256-0555
  • Fax: 405-256-0565
Mailing address:
  • Phone: 405-256-0555
  • Fax: 405-256-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SELMA ALAMI
Title or Position: CO-OWNER/ PHARMACIST-IN-CHARGE
Credential: PHARMD
Phone: 405-256-0555