Provider Demographics
NPI:1164207767
Name:HEROD DRUG, LLC
Entity Type:Organization
Organization Name:HEROD DRUG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-822-3789
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OK
Mailing Address - Zip Code:73724-0419
Mailing Address - Country:US
Mailing Address - Phone:580-886-3444
Mailing Address - Fax:580-886-3445
Practice Address - Street 1:212 W MAIN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OK
Practice Address - Zip Code:73724
Practice Address - Country:US
Practice Address - Phone:580-886-3444
Practice Address - Fax:580-886-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy