Organization
EDGEMAN HEALTH LLC
Active
Other names
THE MEDICINE STORE
Organization subpart
No
Provider details
NPI number
Authorized official
NELSON EDGEMAN PHARMD (PRESIDENT)
(580) 916-5168
Entity
Organization
Contact information
Practice address
311 N. WASHINGTON AVE., DURANT, OK 74701
(580) 924-3784
(580) 920-0048
Mailing address
311 N. WASHINGTON AVE., DURANT, OK 74701
(580) 924-3784
(580) 920-0048
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
27-4393
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100242910A
—
OK
01
—
2074715
PK
—
01
—
5TS-15286924-05
STATE SALES TAX
OK
Enumeration date
10/26/2006
Last updated
11/18/2019
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