Organization
FREDERICK PHARMACY, INC.
Active
Other names
Health Express Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE KELLY DPH (OWNER)
(580) 335-7575
Entity
Organization
Contact information
Practice address
219 E JOSEPHINE, FREDERICK, OK 73542
(580) 335-7575
(580) 335-7577
Mailing address
PO BOX 981, FREDERICK, OK 73542-0981
(580) 335-7575
(580) 335-7577
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200008420A
—
OK
01
—
2072540
PK
—
Enumeration date
08/20/2006
Last updated
02/16/2018
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