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General NPI Number Information
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NPI Number | 1619170628
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Entity Type | Organization
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Legal Business Name | UNITED DISCOUNT DRUG
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 600 E BROADWAY ST
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City | ALTUS
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State | OK
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Zip | 73521-5513
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Country | US
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Telephone | 580-477-0800
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Fax | 580-477-0802
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Provider Business Mailing Address
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Address Line | 600 E BROADWAY ST
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City | ALTUS
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State | OK
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Zip | 73521-5513
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Country | US
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Telephone | 580-477-0800
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Fax | 580-477-0802
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | TERRA BROOKS
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Credential | DPH
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Telephone | 580-477-0800
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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 |
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License Number State | OK
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