Organization
CENTRAL PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY AVANCE (OWNER)
(405) 310-2014
Entity
Organization
Contact information
Practice address
1721 N MAIN ST, SUITE C, ALTUS, OK 73521-2000
(580) 482-3414
(580) 482-3415
Mailing address
PO BOX 722580, NORMAN, OK 73070-8961
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
174718
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100245240A
—
OK
01
—
3703445
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/30/2006
Last updated
06/11/2008
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