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General NPI Number Information
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NPI Number | 1578656732
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Entity Type | Organization
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Legal Business Name | BROADWAY CORNER DRUG
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 101 E SHAWNTEL SMITH BLVD
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City | MULDROW
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State | OK
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Zip | 74948
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Country | US
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Telephone | 918-427-1985
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Fax | 918-427-1157
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Provider Business Mailing Address
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Address Line | PO BOX 1469
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City | MULDROW
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State | OK
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Zip | 74948-1469
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO OWNER DR OF PHY
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Name | RHONDA MCCOMBS
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Credential |
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Telephone | 918-427-1985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 34-3763
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License Number State | OK
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