Organization
DEDMON PHARMACY INC
Active
Other names
Sullins Drugs
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY DEDMON PHARM D (PRESIDENT)
(918) 962-2131
Entity
Organization
Contact information
Practice address
213 W BROADWAY ST, SPIRO, OK 74959-2419
(918) 962-2131
(918) 962-5750
Mailing address
PO BOX 220, SPIRO, OK 74959-0220
(918) 962-2131
(918) 962-5750
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
197806
OK
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100246960B
—
OK
01
—
2073256
PK
—
Enumeration date
09/30/2006
Last updated
02/28/2017
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