Organization
WELEETKA DRUG INCORPORATED
Active
Other names
Weleetka Drug
Organization subpart
No
Provider details
NPI number
Authorized official
GALLEN SHENEMAN (PIC/DPH)
(405) 786-2337
Entity
Organization
Contact information
Practice address
309 W 9TH STREET, WELEETKA, OK 74880-0727
(405) 786-2247
(405) 786-2409
Mailing address
PO BOX 727, WELEETKA, OK 74880-0727
(405) 786-2247
(405) 786-2409
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
51-6952
OK
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200564890A
—
OK
01
—
2148284
PK
—
Enumeration date
11/10/2014
Last updated
10/11/2021
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