Organization
LUCKIE DRUG LLC
Active
Other names
LUCKIE DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
JIM LUCKIE (OWNER)
(580) 822-3789
Entity
Organization
Contact information
Practice address
116 N MAIN ST, OKEENE, OK 73763-9446
(580) 822-3789
(580) 822-3136
Mailing address
PO BOX 549, OKEENE, OK 73763-0549
(580) 822-3789
(580) 822-3136
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
495519
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100246010A
—
OK
01
—
2134003
PK
—
Enumeration date
10/30/2006
Last updated
11/18/2015
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