Organization
CARL'S HOMETOWN PHARMACY LLC
Active
Other names
Carl's Hometown Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CARL CARMON DEASON PHARMACIST (OWNER/PHARMACIST918)
(918) 791-3295
Entity
Organization
Contact information
Practice address
1101 NEO LOOP, GROVE, OK 74344
(918) 791-3295
(918) 791-3296
Mailing address
PO BOX 451689, GROVE, OK 74345-1689
(918) 791-3295
(918) 791-3296
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200983770A
—
OK
01
—
45-8920
STATE PHARMACY LICENSE
OK
Enumeration date
05/05/2021
Last updated
07/05/2021
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