Organization
PRUETTS FOOD INC
Active
Other names
PRUETTS FOOD-PHARMACY#3
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON JEWELANNA PRUETT (PHARMACY DIRECTOR)
(580) 584-6089
Entity
Organization
Contact information
Practice address
500 E COLLIN RAYE DR, DE QUEEN, AR 71832-8048
(870) 642-5680
(870) 642-5683
Mailing address
210 MAIN STREET, BROKEN BOW, OK 74728-4737
(870) 648-5680
(870) 648-5683
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR14401
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190021407A
—
AR
05
—
20001990D
—
OK
01
—
2132858
PK
—
Enumeration date
11/28/2011
Last updated
01/31/2021
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