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General NPI Number Information
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NPI Number | 1912063892
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Entity Type | Organization
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Legal Business Name | GRINNELL PRESCRIPTION SHOP INC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 304 S BROADWAY
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City | HOBART
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State | OK
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Zip | 73651-1862
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Country | US
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Telephone | 580-726-5613
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Fax | 580-726-3511
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Provider Business Mailing Address
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Address Line | PO BOX 192
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City | HOBART
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State | OK
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Zip | 73651-0192
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVE MILLER
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Credential | DPH
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Telephone | 580-726-5613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 413479
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License Number State | OK
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