Healthcare Provider Details

I. General information

NPI: 1780602748
Provider Name (Legal Business Name): YALE DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N MAIN ST
YALE OK
74085-2507
US

IV. Provider business mailing address

121 N MAIN ST
YALE OK
74085-2507
US

V. Phone/Fax

Practice location:
  • Phone: 918-387-4183
  • Fax: 918-387-3200
Mailing address:
  • Phone: 918-387-4183
  • Fax: 918-387-3200

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 Number8-3618
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TROY SIMONS
Title or Position: OWNER
Credential:
Phone: 918-387-4183