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General NPI Number Information
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NPI Number | 1609938349
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Entity Type | Organization
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Legal Business Name | E D ALLENS PHARMACY OF BROKEN BOW INC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 619 S PARK DR
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City | BROKEN BOW
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State | OK
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Zip | 74728-5331
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Country | US
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Telephone | 580-584-5841
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Fax | 580-584-5845
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Provider Business Mailing Address
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Address Line | 619 S PARK DR
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City | BROKEN BOW
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State | OK
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Zip | 74728-5331
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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 | MANAGER
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Name | EDDIE ALLEN
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Credential |
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Telephone | 580-584-5841
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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 | 255237
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License Number State | OK
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