Organization
QBAUM ENTERPRISES LLC
Active
Other names
THE CROSS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN QUATTEBAUM (OWNER)
(918) 824-1300
Entity
Organization
Contact information
Practice address
1025 NE 1ST ST, PRYOR, OK 74361-4003
(918) 824-1300
(918) 824-1316
Mailing address
1025 NE 1ST ST, PRYOR, OK 74361-4003
(918) 824-1300
(918) 824-1316
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
305308
OK
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200205310A
—
OK
05
—
200205310B
—
OK
01
—
2116542
PK
—
Enumeration date
08/08/2008
Last updated
10/20/2023
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