Healthcare Provider Details

I. General information

NPI: 1912090358
Provider Name (Legal Business Name): RICHARDS DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E MAIN ST
SHAWNEE OK
74801-7012
US

IV. Provider business mailing address

324 E MAIN ST
SHAWNEE OK
74801-7012
US

V. Phone/Fax

Practice location:
  • Phone: 405-273-7810
  • Fax: 405-273-3165
Mailing address:
  • Phone: 405-273-7810
  • Fax: 405-273-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number105565
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CINDY MONDAY
Title or Position: TECHNICIAN
Credential:
Phone: 405-273-7810