Organization
TONI'S WESTSIDE REXALL INC
Active
Other names
Toni's Westside Healthmart, TONIS WESTSIDE REXALL INC
Organization subpart
No
Provider details
NPI number
Authorized official
TONI K GIBSON (OWNER/PHARMACISTS)
(580) 765-4456
Entity
Organization
Contact information
Practice address
301 W GRAND AVE, PONCA CITY, OK 74601-5118
(580) 765-4456
(580) 765-0668
Mailing address
301 W GRAND AVE, PONCA CITY, OK 74601-5118
(580) 765-4456
(580) 765-0668
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
62133
OK
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100235620A
—
OK
05
—
100235620B
—
OK
01
—
2073065
PK
—
Enumeration date
07/30/2006
Last updated
01/06/2022
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