Organization
SALLISAWRX LLC
Active
Other names
Sallisaw Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAKOTA RUSSELL TANNER PHARM.D. (MANAGING MEMBER)
(918) 775-4451
Entity
Organization
Contact information
Practice address
1212A E CHEROKEE AVE, SALLISAW, OK 74955-5232
(918) 775-4451
(918) 775-5269
Mailing address
1212A E CHEROKEE AVE, SALLISAW, OK 74955-5232
(918) 775-4451
(918) 775-5269
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100237570A
—
OK
Enumeration date
05/17/2023
Last updated
04/21/2025
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