Organization
SEQUOYAH COUNTY DRUG COMPANY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANDREA JOY SELF DPH (PRESIDENT)
(918) 571-8813
Entity
Organization
Contact information
Practice address
1632 S KERR BLVD, SALLISAW, OK 74955
(918) 774-0089
(918) 774-0890
Mailing address
PO BOX 705, SALLISAW, OK 74955-0705
(918) 571-8813
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200811470A
—
OK
Enumeration date
10/09/2018
Last updated
01/17/2022
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