Healthcare Provider Details

I. General information

NPI: 1821154709
Provider Name (Legal Business Name): SOONER DRUG AND GIFTS OR OKEMAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W BROADWAY ST
OKEMAH OK
74859-2608
US

IV. Provider business mailing address

324 W BROADWAY ST
OKEMAH OK
74859-2608
US

V. Phone/Fax

Practice location:
  • Phone: 918-623-1771
  • Fax: 918-623-0238
Mailing address:
  • Phone: 918-623-1771
  • Fax: 918-623-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number512948
License Number StateOK

VIII. Authorized Official

Name: BERNIE WYATT
Title or Position: OWNER
Credential:
Phone: 918-623-1036