1740369669 NPI number — THOMAS DRUG INC

Table of content: (NPI 1740369669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740369669 NPI number — THOMAS DRUG INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS DRUG INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THOMAS DRUG & VARIETY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740369669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 347
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOMAS
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73669-0347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 W BROADWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOMAS
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73669-8266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-661-3545
Provider Business Practice Location Address Fax Number:
580-661-3540
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOURT
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PIC/OWNER
Authorized Official Telephone Number:
580-661-3545

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 282759 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100235160A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2073270 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com