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General NPI Number Information
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NPI Number | 1407901671
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Entity Type | Organization
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Legal Business Name | TONI'S WESTSIDE REXALL INC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 301 W GRAND AVE
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City | PONCA CITY
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State | OK
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Zip | 74601-5118
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Country | US
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Telephone | 580-765-4456
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Fax | 580-765-0668
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Provider Business Mailing Address
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Address Line | 301 W GRAND AVE
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City | PONCA CITY
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State | OK
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Zip | 74601-5118
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Country | US
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Telephone | 580-765-4456
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Fax | 580-765-0668
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Authorized Official
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Title or Position | CHIEF PHARMACIST OWNER
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Name | MS. TONI K GIBSON
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Credential | DPH
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Telephone | 580-765-4456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 6-2133
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License Number State | OK
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