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General NPI Number Information
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NPI Number | 1245887231
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Entity Type | Organization
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Legal Business Name | DOCTOR STRAINS LLC
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Dates
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Enumeration Date | 08/23/2019
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 39015 BARNHART DR
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City | HOWE
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State | OK
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Zip | 74940-3688
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Country | US
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Telephone | 918-839-4595
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Fax | 918-956-1041
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Provider Business Mailing Address
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Address Line | 39015 BARNHART DR
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City | HOWE
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State | OK
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Zip | 74940-3688
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Country | US
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Telephone | 918-839-4595
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Fax | 918-956-1041
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Authorized Official
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Title or Position | OWNER
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Name | CLAYTON TRAVIS MAYHEW
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Credential | GROWERS LICENCE
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Telephone | 918-839-4595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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