Organization
IDABEL EXPRESS PHARMACY, LLC
Active
Other names
Idabel Express Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN ANN RITTER (OWNER)
(580) 889-1283
Entity
Organization
Contact information
Practice address
810 SE WASHINGTON ST, IDABEL, OK 74745-3332
(580) 245-6169
(580) 208-2372
Mailing address
PO BOX 870, ATOKA, OK 74525-0870
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200875410A
—
OK
Enumeration date
09/23/2019
Last updated
02/04/2020
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