Organization
PRUETT'S FOOD, INC.
Active
Other names
PRUETT'S FOOD-PHARMACY#9
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON PRUETT (PHARMACY SUPERVISOR)
(580) 236-2056
Entity
Organization
Contact information
Practice address
203 E HIGHWAY ST, HOLDENVILLE, OK 74848-4011
(405) 379-6331
(405) 493-0697
Mailing address
210 MAIN ST, BROKEN BOW, OK 74728-3976
(580) 236-2056
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
407925
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200019990F
—
OK
Enumeration date
06/21/2017
Last updated
08/10/2022
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