Organization
VERITAS PROPERTIES LLC
Active
Other names
MAIN STREET DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
DARREN TIDWELL (OWNER)
(918) 465-9300
Entity
Organization
Contact information
Practice address
225 W MAIN ST, WILBURTON, OK 74578-4045
(918) 465-9300
(918) 465-9303
Mailing address
225 W MAIN ST, WILBURTON, OK 74578-4045
(918) 465-9300
(918) 465-9303
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
675089
OK
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200081170A
—
OK
05
—
200081170B
—
OK
01
—
2076464
PK
—
Enumeration date
07/01/2006
Last updated
03/05/2021
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