Organization
UNITED DISCOUNT DRUG INC
Active
Other names
Broadway Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TERRA BROOKS (PHARMACY MANAGER)
(580) 477-0800
Entity
Organization
Contact information
Practice address
601 E BROADWAY ST, ALTUS, OK 73521-5512
(580) 477-0800
(580) 477-0802
Mailing address
601 E BROADWAY ST, ALTUS, OK 73521-5512
(580) 477-0800
(580) 477-0802
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
176355
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100234180A
—
OK
05
—
100234180B
—
OK
01
—
2072623
PK
—
Enumeration date
10/20/2006
Last updated
01/17/2017
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