Organization
HENRYETTA DRUG LLC
Active
Other names
Henryetta Drug
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN JAY RITTER (MANAGER)
(580) 889-0230
Entity
Organization
Contact information
Practice address
623 W MAIN ST, HENRYETTA, OK 74437-4245
(918) 652-3361
(918) 652-9554
Mailing address
744 S MISSISSIPPI AVE, ATOKA, OK 74525-3355
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200900400A
—
OK
Enumeration date
02/28/2020
Last updated
11/08/2021
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