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
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
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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