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General NPI Number Information
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NPI Number | 1295318418
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Entity Type | Organization
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Legal Business Name | CARL'S HOMETOWN PHARMACY LLC
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 07/05/2021
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Provider Practice Location Address
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Address Line | 1101 NEO LOOP
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City | GROVE
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State | OK
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Zip | 74344
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Country | US
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Telephone | 918-791-3295
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Fax | 918-791-3296
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Provider Business Mailing Address
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Address Line | PO BOX 451689
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City | GROVE
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State | OK
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Zip | 74345-1689
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Country | US
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Telephone | 918-791-3295
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Fax | 918-791-3296
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Authorized Official
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Title or Position | OWNER/PHARMACIST918
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Name | CARL CARMON DEASON
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Credential | PHARMACIST
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Telephone | 918-791-3295
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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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