Organization
GORE GREEN COUNTRY DRUG, INC.
Active
Other names
GORE GREEN COUNTRY DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS CRUMPLER (OWNER)
(918) 489-5558
Entity
Organization
Contact information
Practice address
305 N MAIN ST, GORE, OK 74435-0330
(918) 489-5558
(918) 489-5359
Mailing address
PO BOX 330, GORE, OK 74435-0330
(918) 489-5558
(918) 489-5359
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
34-5226
OK
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100234940A
—
OK
01
—
2073565
PK
—
Enumeration date
08/12/2005
Last updated
08/12/2021
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