MEDICARE: RELIABLE DISCOUNT PHARMACY INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	13893	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2081577	OTHER	PK

General Provider Information

NPI Number	:	1134212566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIABLE DISCOUNT PHARMACY INC

Provider Business Mailing Address
First Line	:	5900 S PENNSYLVANIA AVE STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-7029
Country	:	US
Telephone Number	:	405-681-6631
Fax Number	:	405-681-4425

Provider Business Practice Location Address
First Line	:	5900 S PENNSYLVANIA AVE STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-7029
Country	:	US
Telephone Number	:	405-681-6631
Fax Number	:	405-681-4425

Authorized Official
Title or Position	:	OWNER
Name	:	DOUG SISEMORE
Credential	:	PHARMACIST
Telephone Number	:	405-681-6631

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	02/16/2017

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