=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972441905
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HENRY ROBERTS EXPRESS PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2026
-----------------------------------------------------
Last Update Date | 03/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1316 12TH AVE NW
-----------------------------------------------------
City | ARDMORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-223-5828
-----------------------------------------------------
Fax | 580-226-3902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1316 12TH AVE NW
-----------------------------------------------------
City | ARDMORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-223-5828
-----------------------------------------------------
Fax | 580-226-3902
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM DONALD MOORE
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 580-223-5828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------