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General NPI Number Information
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NPI Number | 1164207767
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Entity Type | Organization
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Legal Business Name | HEROD DRUG, LLC
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 212 W MAIN
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City | CANTON
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State | OK
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Zip | 73724
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Country | US
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Telephone | 580-886-3444
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Fax | 580-886-3445
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Provider Business Mailing Address
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Address Line | PO BOX 419
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City | CANTON
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State | OK
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Zip | 73724-0419
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Country | US
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Telephone | 580-886-3444
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Fax | 580-886-3445
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Authorized Official
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Title or Position | CO-OWNER
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Name | JIMMY LUCKIE
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Credential | DPH
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Telephone | 580-822-3789
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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 |
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License Number State |
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