Organization
BROADWAY CORNER DRUG
Active
Other names
BROADWAY CORNER DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA MCCOMBS (CO OWNER DR OF PHY)
(918) 427-1985
Entity
Organization
Contact information
Practice address
101 E SHAWNTEL SMITH BLVD, MULDROW, OK 74948
(918) 427-1985
(918) 427-1157
Mailing address
PO BOX 1469, MULDROW, OK 74948-1469
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
34-3763
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100242810A
—
OK
01
—
2074693
PK
—
Enumeration date
10/02/2006
Last updated
04/19/2016
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