Organization
CRESCENT DRUG STORE INC
Active
Other names
CRESCENT DRUG AND APOTH INC PC
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM WEBBER (PRESIDENT)
(406) 665-4115
Entity
Organization
Contact information
Practice address
116 S DEAN A MCGEE AVE, WYNNEWOOD, OK 73098-7822
(405) 665-4115
(405) 665-5666
Mailing address
116 S DEAN A MCGEE AVE, WYNNEWOOD, OK 73098-7822
(405) 665-4115
(405) 665-5666
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
22-5109
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100232530A
—
OK
01
—
2073349
PK
—
Enumeration date
08/31/2006
Last updated
05/23/2016
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