Healthcare Provider Details

I. General information

NPI: 1558454991
Provider Name (Legal Business Name): ECK DRUG & GIFT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MAIN ST
WAURIKA OK
73573-3053
US

IV. Provider business mailing address

101 S MAIN ST
WAURIKA OK
73573-3053
US

V. Phone/Fax

Practice location:
  • Phone: 580-228-2383
  • Fax: 580-228-3290
Mailing address:
  • Phone: 580-228-2383
  • Fax: 580-228-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number63-2970
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DANA ECK
Title or Position: DPH/PRES
Credential:
Phone: 580-228-2383