Organization
PRUETT'S FOOD, INC.
Active
Other names
PRUETT'S FOOD-PHARMACY#8
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON PRUETT (PHARMACY SUPERVISOR)
(580) 236-2056
Entity
Organization
Contact information
Practice address
1231 N WASHINGTON AVE, DURANT, OK 74701-2119
(580) 924-2903
(580) 924-7337
Mailing address
210 MAIN ST, BROKEN BOW, OK 74728-3976
(580) 236-2056
(580) 584-6088
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
277924
OK
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200019990G
—
OK
01
—
2169410
PK
—
Enumeration date
06/14/2017
Last updated
06/28/2020
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