Organization
DEDMON PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY WAYNE DEDMON PHARM D (PRESIDENT)
(918) 962-2131
Entity
Organization
Contact information
Practice address
213 W BROADWAY ST, SPIRO, OK 74959-2419
(918) 962-2131
(918) 962-5750
Mailing address
PO BOX 220, SPIRO, OK 74959-0220
(918) 962-2131
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100246960B
—
OK
Enumeration date
03/22/2019
Last updated
03/22/2019
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