Organization
FREDERICK PHARMACY INC
Active
Other names
FREDERICK PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE KELLY (OWNER)
(580) 335-5501
Entity
Organization
Contact information
Practice address
1600 N MAIN ST, FREDERICK, OK 73542-1419
(580) 335-5501
(580) 335-7253
Mailing address
PO BOX 981, FREDERICK, OK 73542-0981
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
424719
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200015150A
—
OK
01
—
3711012
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/20/2006
Last updated
10/14/2019
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