Healthcare Provider Details

I. General information

NPI: 1326151846
Provider Name (Legal Business Name): THOMAS DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W MAIN ST
WATONGA OK
73772-4233
US

IV. Provider business mailing address

407 W MAIN ST
WATONGA OK
73772-4233
US

V. Phone/Fax

Practice location:
  • Phone: 580-623-4505
  • Fax: 580-623-4627
Mailing address:
  • Phone: 580-623-4505
  • Fax: 580-623-4627

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 Number49-5139
License Number StateOK

VIII. Authorized Official

Name: ALEX KOURT
Title or Position: OWNER
Credential: DPH
Phone: 580-623-4545