Organization
CANADIAN VALLEY RX, INC.
Active
Other names
CANADIAN VALLEY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN THOMAS SMITH PHARM.D. (CO OWNER/MANAGER)
(405) 262-4154
Entity
Organization
Contact information
Practice address
1605 W. ELM STREET, EL RENO, OK 73036
(405) 262-4154
(405) 262-0912
Mailing address
1605 W. ELM STREET, EL RENO, OK 73036
(405) 262-4154
(405) 262-0912
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
26-8078
OK
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100803650B
—
OK
05
—
100803650C
—
OK
01
—
2072539
PK
—
Enumeration date
08/09/2006
Last updated
08/10/2018
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