Organization
PHARMOLOGY TISHMINGO ACQUISITION LLC
Active
Other names
Tishomingo Express Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN RITTER DPH (OWNER)
(580) 889-0230
Entity
Organization
Contact information
Practice address
140 E MAIN ST, TISHOMINGO, OK 73460-2838
(580) 371-2355
(580) 371-0000
Mailing address
744 S MISSISSIPPI AVE STE A, ATOKA, OK 74525-3356
(580) 371-2355
(580) 371-0000
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200909800
—
OK
Enumeration date
06/05/2020
Last updated
12/15/2020
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