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General NPI Number Information
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NPI Number | 1134545999
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Entity Type | Organization
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Legal Business Name | OLIVERS EXPRESS PHARMACY LLC
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 05/14/2020
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Provider Practice Location Address
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Address Line | 624 N MAIN ST
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City | FAIRVIEW
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State | OK
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Zip | 73737-1216
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Country | US
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Telephone | 580-227-4000
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Fax | 580-227-4003
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Provider Business Mailing Address
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Address Line | PO BOX 250
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City | FAIRVIEW
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State | OK
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Zip | 73737-0250
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Country | US
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Telephone | 580-227-4000
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Fax | 580-227-4003
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Authorized Official
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Title or Position | OWNER/PHARMACIST IN CHARGE
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Name | OLIVER GARY LACKEY
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Credential | PHARMD
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Telephone | 580-744-1401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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