Organization
SOONER PHARMACY INC OF TISHOMINGO
Active
Other names
SOONER PHARMACY INC OF TISHOMINGO
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE LAFEVERS (PRES AND MGR)
(580) 371-9509
Entity
Organization
Contact information
Practice address
101 S BYRD ST, TISHOMINGO, OK 73460-2216
(580) 371-9509
(580) 371-9252
Mailing address
101 S BYRD ST, TISHOMINGO, OK 73460-2216
(580) 371-9509
(580) 371-9252
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
61-3493
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100238360A
—
OK
01
—
3714575
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/03/2006
Last updated
02/07/2011
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