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NPI 1215643226

NPI 1215643226 : CRESCENT DRUG AND APOTHECARY LLC : WYNNEWOOD, OK

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General NPI Number Information
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    NPI Number           |    1215643226
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    Entity Type          |    Organization 
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    Legal Business Name  |    CRESCENT DRUG AND APOTHECARY LLC 
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Dates
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    Enumeration Date     |    01/24/2023
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    Last Update Date     |    01/24/2023
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Provider Practice Location Address
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    Address Line         |    116 S DEAN A MCGEE AVE 
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    City                 |    WYNNEWOOD
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    State                |    OK
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    Zip                  |    73098-7822
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    Country              |    US
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    Telephone            |    405-665-4115
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    Fax                  |    405-665-5666
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Provider Business Mailing Address
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    Address Line         |    116 S DEAN A MCGEE AVE 
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    City                 |    WYNNEWOOD
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    State                |    OK
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    Zip                  |    73098-7822
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    Country              |    US
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    Telephone            |    405-665-4115
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    Fax                  |    405-665-5666
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |     RORY  FORINASH 
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    Credential           |    
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    Telephone            |    405-212-3177
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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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