Organization
BRINE AND BEAM INC
Active
Other names
Apothecary Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS WOLFF (VICE-PRESIDENT)
(918) 306-1839
Entity
Organization
Contact information
Practice address
1419 COMMERCIAL AVE, MOUNDS, OK 74047-0580
(918) 827-6301
Mailing address
PO BOX 580, MOUNDS, OK 74047-0580
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Enumeration date
11/15/2018
Last updated
11/15/2018
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