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General NPI Number Information
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NPI Number | 1659063246
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Entity Type | Organization
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Legal Business Name | POTEAU FAMILY PHARMACY, LLC
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Dates
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Enumeration Date | 05/23/2023
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 1122 TARBY ROAD
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City | POTEAU
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State | OK
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Zip | 74953
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Country | US
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Telephone | 918-647-0453
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 TARBY ROAD
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City | POTEAU
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State | OK
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Zip | 74953
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Country | US
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Telephone | 918-647-0453
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | THOMAS CRANDELL
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Credential |
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Telephone | 918-647-0453
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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 |
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