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Organization
FOSTER CORNER DRUG LONG TERM CARE
Active
Organization
FOSTER CORNER DRUG LONG TERM CARE
Active
Other names
Foster Corner Drug Long Term Care
Organization subpart
No
Provider details
NPI number
Authorized official
TROY SIMONS (PRESIDENT)
(405) 372-4882
Entity
Organization
Contact information
Practice address
328 N 6TH ST, PERRY, OK 73077-6607
(580) 336-2136
(580) 336-9445
Mailing address
328 N 6TH ST, PERRY, OK 73077-6607
(580) 336-2136
(580) 336-9445
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
NULL
3336C0004X
Compounding Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
3336S0011X
Specialty Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100232570A
—
OK
Enumeration date
08/21/2019
Last updated
10/19/2020
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