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General NPI Number Information
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NPI Number | 1144328956
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Entity Type | Organization
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Legal Business Name | MEDICINE CHEST PHARMACY CO
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 201 S BICKFORD AVE
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City | EL RENO
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State | OK
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Zip | 73036-5600
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Country | US
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Telephone | 405-262-1222
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Fax | 405-262-0033
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Provider Business Mailing Address
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Address Line | 201 S BICKFORD AVE
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City | EL RENO
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State | OK
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Zip | 73036-5600
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Country | US
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Telephone | 405-262-1222
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Fax | 405-262-0033
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Authorized Official
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Title or Position | PRES & OWNER
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Name | MR. WILLARD DEAN HOLSTED
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Credential | DPH
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Telephone | 405-262-1835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | OKLA7497
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License Number State | OK
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