Organization
PRUETTS FOOD INC
Active
Other names
PRUETTS FOOD-PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON PRUETT (PHARMACY DIRECTOR)
(580) 236-2056
Entity
Organization
Contact information
Practice address
202 W CHAPPELL DR, VALLIANT, OK 74764-9135
(580) 933-5745
(580) 933-5750
Mailing address
210 MAIN STREET, BROKEN BOW, OK 74728-4737
(580) 933-5745
(580) 933-5750
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
25-6949
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200019990C
—
OK
01
—
2121548
PK
—
Enumeration date
08/09/2009
Last updated
11/28/2021
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