Organization
THOMAS DRUG INC
Active
Other names
Eagle Compounding Center
Organization subpart
No
Provider details
NPI number
Authorized official
JAY KOURT (PRESIDENT)
(580) 661-3549
Entity
Organization
Contact information
Practice address
3741 LEGACY, WEATHERFORD, OK 73096-9746
(580) 772-2672
(580) 772-2204
Mailing address
3741 LEGACY, WEATHERFORD, OK 73096-9746
(580) 772-2672
(580) 772-2204
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
286889
OK
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148810
PK
—
Enumeration date
10/20/2014
Last updated
01/20/2015
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