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General NPI Number Information
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NPI Number | 1104145846
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Entity Type | Organization
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Legal Business Name | BMTTH LLC
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 2432 W MAIN ST
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City | DURANT
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State | OK
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Zip | 74701-4807
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Country | US
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Telephone | 580-920-1400
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Fax | 580-920-1451
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Provider Business Mailing Address
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Address Line | 2432 W MAIN ST
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City | DURANT
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State | OK
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Zip | 74701-4807
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Country | US
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Telephone | 580-920-1400
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Fax | 580-920-1451
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Authorized Official
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Title or Position | MANAGER
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Name | MICHELE OLLER
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Credential |
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Telephone | 405-761-7932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 27-7201
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License Number State | OK
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