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General NPI Number Information
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NPI Number | 1669885828
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Entity Type | Organization
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Legal Business Name | HENRY ROBERTS EXPRESS PHARMACY
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 1316 12TH AVE NW
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City | ARDMORE
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State | OK
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Zip | 73401-1285
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Country | US
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Telephone | 580-223-5828
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Fax | 580-226-3902
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Provider Business Mailing Address
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Address Line | 1316 12TH AVE NW
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City | ARDMORE
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State | OK
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Zip | 73401-1285
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Country | US
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Telephone | 580-223-5828
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Fax | 580-226-3902
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | DR. WILLIAM DONALD MOORE
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Credential | PHARMD
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Telephone | 580-223-5828
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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 | 125653
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License Number State | OK
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