Organization
CITY DRUG OF IDABEL INC
Active
Other names
CITY DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY NICHOLSON RPH (OWNER)
(580) 286-3235
Entity
Organization
Contact information
Practice address
12 S CENTRAL AVE, IDABEL, OK 74745-4626
(580) 286-3235
(580) 286-3016
Mailing address
12 S CENTRAL AVE, IDABEL, OK 74745-4626
(580) 286-3235
(580) 286-3016
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
25-2838
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100237680A
—
OK
01
—
2073563
PK
—
Enumeration date
09/30/2006
Last updated
07/02/2014
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