Organization
BALTRO LLC
Active
Other names
Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIE JAMES HIGGINS D.PH. (OWNER/D.PH.)
(918) 245-3791
Entity
Organization
Contact information
Practice address
124 COONROD AVE, MANNFORD, OK 74044-3290
(918) 865-2164
(918) 865-7933
Mailing address
5828 S 170TH WEST AVE, SAND SPRINGS, OK 74063-2312
(918) 245-3791
(918) 245-3791
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
11-6040
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-6040
OKLAHOMA STATE BOARD OF PHARMACY RETAIL LICENSE NUMBER
OK
Enumeration date
08/20/2012
Last updated
08/20/2012
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