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General NPI Number Information
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NPI Number | 1962053843
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Entity Type | Organization
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Legal Business Name | IDABEL EXPRESS PHARMACY, LLC
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 810 SE WASHINGTON ST
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City | IDABEL
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State | OK
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Zip | 74745-3332
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Country | US
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Telephone | 580-245-6169
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Fax | 580-208-2372
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Provider Business Mailing Address
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Address Line | PO BOX 870
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City | ATOKA
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State | OK
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Zip | 74525-0870
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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 | SUSAN ANN RITTER
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Credential |
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Telephone | 580-889-1283
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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 |
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License Number State |
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Taxonomy #2
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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 #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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