Provider Demographics
NPI:1114089760
Name:YALE DRUG, INC
Entity Type:Organization
Organization Name:YALE DRUG, INC
Other - Org Name:YALE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST AND OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:918-387-4183
Mailing Address - Street 1:121 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:OK
Mailing Address - Zip Code:74085-2507
Mailing Address - Country:US
Mailing Address - Phone:918-387-4183
Mailing Address - Fax:918-387-3200
Practice Address - Street 1:121 N MAIN ST
Practice Address - Street 2:
Practice Address - City:YALE
Practice Address - State:OK
Practice Address - Zip Code:74085-2507
Practice Address - Country:US
Practice Address - Phone:918-387-4183
Practice Address - Fax:918-387-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4412790001Medicare NSC