Provider Demographics
NPI:1225121650
Name:TRB DRUGS INC
Entity Type:Organization
Organization Name:TRB DRUGS INC
Other - Org Name:QUALITY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-749-4200
Mailing Address - Street 1:3414 S YALE AVE
Mailing Address - Street 2:STE F
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-8035
Mailing Address - Country:US
Mailing Address - Phone:918-749-4200
Mailing Address - Fax:918-749-4500
Practice Address - Street 1:3414 S YALE AVE
Practice Address - Street 2:STE F
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-8035
Practice Address - Country:US
Practice Address - Phone:918-749-4200
Practice Address - Fax:918-749-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK2-45993336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100234060AMedicaid
3700285OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OK100234060AMedicaid