Organization
HOMINY REXALL INC
Active
Other names
HOMINY REXALL DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN SNIDER (OWNER PHCST)
(918) 885-2715
Entity
Organization
Contact information
Practice address
104 W MAIN ST, HOMINY, OK 74035-1032
(918) 885-2715
(918) 885-4516
Mailing address
104 W MAIN ST, HOMINY, OK 74035-1032
(918) 885-2715
(918) 885-4516
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
162545
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100237360A
—
OK
01
—
2072812
PK
—
Enumeration date
10/26/2006
Last updated
07/02/2014
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