Organization
EVANS SPECIALTY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE KEITH WHITEHEAD (OWNER/PHARMACIST)
(580) 234-4343
Entity
Organization
Contact information
Practice address
1110 W WILLOW RD, ENID, OK 73703-2503
(580) 242-1116
Mailing address
1110 W WILLOW RD, ENID, OK 73703-2503
Taxonomy
Speciality
Code
Description
License number
State
3336S0011X
Specialty Pharmacy
Primary
5-5173
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5-5173
STATE LICENSE
OK
Enumeration date
06/05/2007
Last updated
04/01/2010
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