MEDICARE: OKMULGEE DISCOUNT PHARMACY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1033801105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKMULGEE DISCOUNT PHARMACY, LLC

Provider Business Mailing Address
First Line	:	744 S MISSISSIPPI AVE
Second Line	:
City	:	ATOKA
State	:	OK
Zip	:	74525-3355
Country	:	US
Telephone Number	:	580-889-3353
Fax Number	:	580-889-3060

Provider Business Practice Location Address
First Line	:	1160 S BELMONT AVE
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6308
Country	:	US
Telephone Number	:	918-756-1223
Fax Number	:	918-756-3205

Authorized Official
Title or Position	:	OWNER
Name	:	RYAN JAY RITTER
Credential	:	D.PH.
Telephone Number	:	580-889-0230

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	06/05/2023

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