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General NPI Number Information
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NPI Number | 1003967373
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Entity Type | Organization
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Legal Business Name | PHILLIPS DRUG
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1925 W OWEN K GARRIOTT RD
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City | ENID
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State | OK
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Zip | 73703-5528
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Country | US
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Telephone | 580-402-2342
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Fax |
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Provider Business Mailing Address
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Address Line | 1925 W OWEN K GARRIOTT RD
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City | ENID
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State | OK
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Zip | 73703-5528
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Country | US
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Telephone | 580-402-2342
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JULIE ANN PHILLIPS
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Credential |
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Telephone | 580-402-2342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5-1102
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License Number State | OK
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