Healthcare Provider Details

I. General information

NPI: 1457440141
Provider Name (Legal Business Name): ROYS DISCOUNT PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 HIGHWAY 2 N
WILBURTON OK
74578-3620
US

IV. Provider business mailing address

621 HIGHWAY 2 N
WILBURTON OK
74578-3620
US

V. Phone/Fax

Practice location:
  • Phone: 918-465-0111
  • Fax: 918-465-0015
Mailing address:
  • Phone: 918-465-0111
  • Fax: 800-901-8542

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 Number67-4554
License Number StateOK

VIII. Authorized Official

Name: TAWNEE D TAYLOR
Title or Position: OWNER
Credential:
Phone: 918-465-0111