Organization
SOONER PHARMACY OF OKLAHOMA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY DEWAYNE HALL (MANAGER)
(580) 622-2208
Entity
Organization
Contact information
Practice address
815 W BROADWAY AVE, SULPHUR, OK 73086-4611
(580) 622-2208
(580) 622-2212
Mailing address
815 W BROADWAY AVE, SULPHUR, OK 73086-4611
(580) 622-2208
(580) 622-2212
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
55-6470
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-6470
OKLAHOMA STATE BOARD OF PHARMACY
OK
Enumeration date
11/05/2013
Last updated
11/05/2013
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