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General NPI Number Information
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NPI Number | 1700940491
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Entity Type | Organization
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Legal Business Name | CALVIN HARKINS DBA CORNER DRUG STORE
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 E MAIN ST
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City | MADILL
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State | OK
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Zip | 73446-2239
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Country | US
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Telephone | 580-795-3376
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Fax | 580-795-3255
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Provider Business Mailing Address
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Address Line | 100 E MAIN ST
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City | MADILL
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State | OK
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Zip | 73446-2239
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Country | US
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Telephone | 580-795-3376
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Fax | 580-795-3255
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Authorized Official
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Title or Position | OWNER
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Name | DR. CALVIN R HARKINS
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Credential | DPH
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Telephone | 580-795-3376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 684095
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License Number State | OK
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