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General NPI Number Information
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NPI Number | 1508882143
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Entity Type | Organization
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Legal Business Name | GADDY DISCOUNT DRUG LLC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 1126 W BROADWAY ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-6246
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Country | US
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Telephone | 918-682-5584
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Fax | 918-682-5585
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Provider Business Mailing Address
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Address Line | 1126 W BROADWAY ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-6246
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Country | US
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Telephone | 918-682-5584
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Fax | 918-682-5585
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT AUSTIN YATES
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Credential |
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Telephone | 918-943-0363
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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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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 4-5023
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License Number State | OK
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