Organization
JERRY BENNETT
Active
Other names
JERRYS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY BENNETT (OWNER)
(580) 347-2519
Entity
Organization
Contact information
Practice address
221 MAIN STREET, MOUNTAIN VIEW, OK 73062-0720
(580) 347-2519
(580) 347-2319
Mailing address
PO BOX 140, MOUNTAIN VIEW, OK 73062-0140
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
413679
OK
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100232770A
—
OK
01
—
2072969
PK
—
Enumeration date
10/26/2006
Last updated
11/18/2015
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