Organization
GRANITE DRUG, INC
Active
Other names
GRANITE DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
LIONEL CROSS DPH (PHARM IN CHARGE)
(580) 535-2130
Entity
Organization
Contact information
Practice address
316 MAIN ST, GRANITE, OK 73547-0158
(580) 535-2130
(580) 535-2001
Mailing address
PO BOX 158, GRANITE, OK 73547-0158
(580) 535-2001
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
601729
OK
3336C0004X
Compounding Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100232860A
—
OK
01
—
2072794
PK
—
Enumeration date
11/07/2006
Last updated
07/23/2015
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