Organization
TAHLEQUAH DRUG COMPANY LLC
Active
Other names
TAHLEQUAH DRUG COMPANY
Organization subpart
No
Provider details
NPI number
Authorized official
SHANON GOWER (OWNER)
(918) 931-9222
Entity
Organization
Contact information
Practice address
2028 MAHANEY AVE, TAHLEQUAH, OK 74464-5783
(918) 431-0555
(918) 431-0316
Mailing address
2028 MAHANEY AVE, TAHLEQUAH, OK 74464-5783
(918) 431-0555
(918) 431-0316
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
—
200033290A
—
OK
01
—
2076569
PK
—
Enumeration date
08/18/2005
Last updated
04/08/2021
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