1770665572 NPI number — DON'S DISCOUNT PHARMACY

Table of content: MISS KELLY PRITCHARD CLENDANIEL M.S., SLP (NPI 1922151620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770665572 NPI number — DON'S DISCOUNT PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DON'S DISCOUNT PHARMACY
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:
Provider Other Organization Name Type Code:
6
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:
1770665572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 WEST MAIN
Provider Second Line Business Mailing Address:
DON'S DISCOUNT PHARMACY
Provider Business Mailing Address City Name:
PURCELL
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-527-2186
Provider Business Mailing Address Fax Number:
405-527-2713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 WEST MAIN
Provider Second Line Business Practice Location Address:
DON'S DISCOUNT PHARMACY
Provider Business Practice Location Address City Name:
PURCELL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-527-2186
Provider Business Practice Location Address Fax Number:
405-527-2713
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOOLLY
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
DON
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-527-2186

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  475293 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 47-5293 , 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: 100234930A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3707392 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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