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General NPI Number Information
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NPI Number | 1548629579
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Entity Type | Organization
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Legal Business Name | BLACKWELL PHARMACY LLC
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 1004 W DOOLIN AVE
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City | BLACKWELL
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State | OK
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Zip | 74631-1354
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Country | US
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Telephone | 580-363-2137
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Fax | 580-363-5582
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Provider Business Mailing Address
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Address Line | 14101 N EASTERN AVE STE A
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City | EDMOND
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State | OK
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Zip | 73013-5860
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Country | US
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Telephone | 580-284-7896
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/MANAGER
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Name | DAVID L GEORGE
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Credential |
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Telephone | 580-284-7896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 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 #4
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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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