Healthcare Provider Details

I. General information

NPI: 1639249444
Provider Name (Legal Business Name): BIVENS DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 N MAIN
SEILING OK
73663-0426
US

IV. Provider business mailing address

PO BOX 426
SEILING OK
73663-0426
US

V. Phone/Fax

Practice location:
  • Phone: 580-922-4812
  • Fax: 580-922-4900
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number705920
License Number StateOK

VIII. Authorized Official

Name: JERRY DENNIS
Title or Position: PRESIDENT
Credential:
Phone: 580-922-4812