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General NPI Number Information
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NPI Number | 1821154709
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Entity Type | Organization
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Legal Business Name | SOONER DRUG AND GIFTS OR OKEMAH
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 324 W BROADWAY ST
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City | OKEMAH
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State | OK
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Zip | 74859-2608
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Country | US
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Telephone | 918-623-1771
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Fax | 918-623-0238
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Provider Business Mailing Address
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Address Line | 324 W BROADWAY ST
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City | OKEMAH
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State | OK
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Zip | 74859-2608
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Country | US
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Telephone | 918-623-1771
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Fax | 918-623-0238
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Authorized Official
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Title or Position | OWNER
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Name | BERNIE WYATT
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Credential |
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Telephone | 918-623-1036
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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 | 512948
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License Number State | OK
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