Organization
DRUG STORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN MATLOCK (CO OWNER MGR)
(405) 733-2881
Entity
Organization
Contact information
Practice address
2801 PARKLAWN DR STE 102, MIDWEST CITY, OK 73110-4224
(405) 733-2881
(405) 733-3007
Mailing address
2801 PARKLAWN DR, SUITE 102, MIDWEST CITY, OK 73110-4211
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
13941
OK
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3709447
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/10/2006
Last updated
02/04/2008
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