Organization
BLACK DRUG INC
Active
Other names
BLACK DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BLACK (PRESIDENT)
(918) 479-5223
Entity
Organization
Contact information
Practice address
412 E MAIN ST, LOCUST GROVE, OK 74352-5117
(918) 479-5223
(918) 479-6510
Mailing address
PO BOX 669, LOCUST GROVE, OK 74352-0669
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
30-4476
OK
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100232740A
—
OK
01
—
2081532
PK
—
Enumeration date
01/16/2007
Last updated
09/27/2016
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