Provider Demographics
NPI:1225148547
Name:MCALISTER DRUG CORPORATION
Entity Type:Organization
Organization Name:MCALISTER DRUG CORPORATION
Other - Org Name:CONRAD MARR DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MCALISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-354-2582
Mailing Address - Street 1:948 S YUKON PKWY
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4589
Mailing Address - Country:US
Mailing Address - Phone:405-354-2582
Mailing Address - Fax:405-350-2102
Practice Address - Street 1:948 S YUKON PKWY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4589
Practice Address - Country:US
Practice Address - Phone:405-354-2582
Practice Address - Fax:405-350-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2645383336C0003X, 3336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2081639OtherPK
OK100232450AMedicaid
OK100232450AMedicaid