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General NPI Number Information
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NPI Number | 1912984188
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Entity Type | Organization
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Legal Business Name | GLN OF ADA DOLLAR SAVER, INC
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 1601 N BROADWAY AVE
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City | ADA
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State | OK
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Zip | 74820-1403
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Country | US
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Telephone | 580-436-0900
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Fax | 580-332-2541
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Provider Business Mailing Address
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Address Line | 1601 N BROADWAY AVE
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City | ADA
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State | OK
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Zip | 74820-1403
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Country | US
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Telephone | 580-436-0900
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Fax | 580-332-2541
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DR. BILL MURRAY
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Credential | DPH
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Telephone | 580-436-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 23-4374
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License Number State | OK
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