Provider Demographics
NPI:1194014704
Name:CARTERS DRUG INC
Entity Type:Organization
Organization Name:CARTERS DRUG INC
Other - Org Name:CARTER'S DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-799-7400
Mailing Address - Street 1:1400 SE 4TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-7329
Mailing Address - Country:US
Mailing Address - Phone:405-799-7400
Mailing Address - Fax:405-799-7405
Practice Address - Street 1:1400 SE 4TH ST STE E
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-7328
Practice Address - Country:US
Practice Address - Phone:405-735-9600
Practice Address - Fax:405-735-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK756813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129952OtherPK
OK200332400AMedicaid