Healthcare Provider Details

I. General information

NPI: 1174921316
Provider Name (Legal Business Name): CDL CENTRAL DRUG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 W 12TH AVE
STILLWATER OK
74074-4668
US

IV. Provider business mailing address

1220 W 12TH AVE
STILLWATER OK
74074-4668
US

V. Phone/Fax

Practice location:
  • Phone: 405-372-6120
  • Fax: 405-372-2833
Mailing address:
  • Phone: 405-372-6120
  • Fax: 405-372-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8-6924
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number8-6924
License Number StateOK

VIII. Authorized Official

Name: STEPHEN BAYER
Title or Position: PRESIDENT/PIC
Credential:
Phone: 405-372-6120