Organization
JERRYS PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY DENNIS (OWNER)
(580) 824-1741
Entity
Organization
Contact information
Practice address
1549 MAIN ST, WAYNOKA, OK 73860-2008
(580) 824-1741
(580) 824-2172
Mailing address
1549 MAIN ST, WAYNOKA, OK 73860-2008
(580) 824-1741
(580) 824-2172
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
502796
OK
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100238740A
—
OK
01
—
3713179
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/30/2006
Last updated
06/17/2008
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