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General NPI Number Information
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NPI Number | 1053418996
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Entity Type | Organization
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Legal Business Name | EDREI, LLC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 1721 W 6TH AVE
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City | STILLWATER
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State | OK
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Zip | 74074-4200
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Country | US
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Telephone | 405-372-3331
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Fax | 405-372-3547
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Provider Business Mailing Address
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Address Line | 1721 W 6TH AVE
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City | STILLWATER
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State | OK
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Zip | 74074-4200
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Country | US
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Telephone | 405-372-3331
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Fax | 405-372-3547
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | LISA HLADIK
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Credential |
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Telephone | 405-372-3331
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 83581
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License Number State | OK
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