Organization
OLIVERS EXPRESS PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLIVER GARY LACKEY PHARMD (OWNER/PHARMACIST IN CHARGE)
(580) 744-1401
Entity
Organization
Contact information
Practice address
624 N MAIN ST, FAIRVIEW, OK 73737-1216
(580) 227-4000
(580) 227-4003
Mailing address
PO BOX 250, FAIRVIEW, OK 73737-0250
(580) 227-4000
(580) 227-4003
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
—
200531040A
—
OK
Enumeration date
03/17/2014
Last updated
05/14/2020
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