Organization
KIDD HEALTHMART DRUG CO
Active
Other names
KIDD DRUGS GIFT INC
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN KIDD MARTENS (PRESIDENT)
(580) 227-4685
Entity
Organization
Contact information
Practice address
104 N MAIN ST, FAIRVIEW, OK 73737-1621
(580) 227-4685
(580) 227-2351
Mailing address
104 N MAIN ST, FAIRVIEW, OK 73737-1621
(580) 227-4685
(580) 227-2351
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
66-2590
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100237780A
—
OK
01
—
2072788
PK
—
Enumeration date
01/24/2007
Last updated
02/20/2017
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