Healthcare Provider Details

I. General information

NPI: 1558968958
Provider Name (Legal Business Name): WESTVILLE DRUG COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S. WILLIAMS ST
WESTVILLE OK
74965-7496
US

IV. Provider business mailing address

PO BOX 405
WESTVILLE OK
74965-0405
US

V. Phone/Fax

Practice location:
  • Phone: 918-723-5466
  • Fax: 918-723-4465
Mailing address:
  • Phone: 918-723-5466
  • Fax: 918-723-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JASON DANIEL CARTER
Title or Position: OWNER/CEO
Credential: PHARMD
Phone: 918-723-5466