Organization
GREEN COUNTRY RX LLC
Active
Other names
Bennett's Route 66 Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JARED BENNETT (OWNER)
(918) 406-6703
Entity
Organization
Contact information
Practice address
700 N LYNN RIGGS BLVD, CLAREMORE, OK 74017-5623
(918) 342-8050
(918) 342-8099
Mailing address
700 N LYNN RIGGS BLVD, CLAREMORE, OK 74017-5623
(918) 342-8050
(918) 342-8099
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
29-6213
OK
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200486060A
—
OK
01
—
2139596
PK
—
Enumeration date
03/28/2013
Last updated
01/05/2022
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