Organization
SALLISAW PHARMACY INC
Active
Other names
SALLISAW PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY RISLEY DPH (PRESIDENT)
(918) 775-4451
Entity
Organization
Contact information
Practice address
1212A E CHEROKEE, SALLISAW, OK 74955-5231
(918) 775-4451
(918) 775-5269
Mailing address
1212A E CHEROKEE, SALLISAW, OK 74955-5231
(918) 775-4451
(918) 775-5269
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
34-3071
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100237570A
—
OK
01
—
2073858
PK
—
Enumeration date
07/19/2006
Last updated
02/16/2017
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