Healthcare Provider Details

I. General information

NPI: 1538230354
Provider Name (Legal Business Name): BAYLESS DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MAIN
STRATFORD OK
74872-0150
US

IV. Provider business mailing address

PO BOX 150
STRATFORD OK
74872-0150
US

V. Phone/Fax

Practice location:
  • Phone: 580-759-2312
  • Fax: 580-759-3233
Mailing address:
  • Phone: 580-759-2312
  • Fax: 580-759-3233

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 Number223221
License Number StateOK

VIII. Authorized Official

Name: JULIE JUSTICE
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 405-447-3911