Healthcare Provider Details

I. General information

NPI: 1639592330
Provider Name (Legal Business Name): CHEROKEE HILLS DRUG COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 S MUSKOGEE AVE STE D
TAHLEQUAH OK
74464-5440
US

IV. Provider business mailing address

1607 S MUSKOGEE AVE STE D
TAHLEQUAH OK
74464-5440
US

V. Phone/Fax

Practice location:
  • Phone: 918-456-2531
  • Fax: 918-456-2586
Mailing address:
  • Phone: 918-456-2531
  • Fax: 918-456-2586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JASON DANIEL CARTER
Title or Position: OWNER/CEO
Credential: PHARMD
Phone: 918-456-2531