Organization
DISHMAN PHARMACY INC
Active
Other names
Dishman's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MARK CORRALES (SECRETARY)
(580) 353-8561
Entity
Organization
Contact information
Practice address
1310 SW LEE BLVD, LAWTON, OK 73501-5610
(580) 353-8561
Mailing address
PO BOX 306, LAWTON, OK 73502-0306
(580) 353-8561
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
3-5500
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3702948
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/08/2005
Last updated
11/21/2011
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