Organization
HARRISON DISCOUNT PHARMACY PLLC
Active
Other names
HARRISON DISCOUNT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID NICKLAS (OWNER)
(405) 273-9906
Entity
Organization
Contact information
Practice address
1442 N HARRISON AVE, SHAWNEE, OK 74801-5208
(405) 273-9906
(405) 273-4329
Mailing address
1442 N HARRISON AVE, SHAWNEE, OK 74801-5208
(405) 273-9906
(405) 273-4329
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
104728
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100239400A
—
OK
01
—
2074147
PK
—
Enumeration date
10/26/2006
Last updated
02/17/2016
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