Healthcare Provider Details

I. General information

NPI: 1225168537
Provider Name (Legal Business Name): ROLAND PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E RAY FINE BLVD
ROLAND OK
74954-5198
US

IV. Provider business mailing address

PO BOX 520
ROLAND OK
74954-0520
US

V. Phone/Fax

Practice location:
  • Phone: 918-427-3219
  • Fax: 918-427-3210
Mailing address:
  • Phone: 918-427-3219
  • Fax: 918-427-3210

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 Number342334
License Number StateOK

VIII. Authorized Official

Name: BERRYE SMITH
Title or Position: OWNER
Credential:
Phone: 918-427-3219