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General NPI Number Information
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NPI Number | 1609093681
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Entity Type | Organization
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Legal Business Name | MARK'S PRESCRIPTION SHOP INC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 12/09/2011
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Provider Practice Location Address
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Address Line | 1530 S CHOCTAW RD STE A
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City | CHOCTAW
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State | OK
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Zip | 73020-7096
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Country | US
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Telephone | 405-390-3205
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Fax | 405-390-3206
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Provider Business Mailing Address
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Address Line | 1530 S CHOCTAW RD STE A
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City | CHOCTAW
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State | OK
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Zip | 73020-7096
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Country | US
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Telephone | 405-390-3205
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Fax | 405-390-3206
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. MATT EVANS
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Credential | D.PH.
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Telephone | 405-390-3205
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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 | 1-4081
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License Number State | OK
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