Provider Demographics
NPI:1558968958
Name:WESTVILLE DRUG COMPANY LLC
Entity Type:Organization
Organization Name:WESTVILLE DRUG COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:918-723-5466
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74965-0405
Mailing Address - Country:US
Mailing Address - Phone:918-723-5466
Mailing Address - Fax:918-723-4465
Practice Address - Street 1:301 S. WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:OK
Practice Address - Zip Code:74965-7496
Practice Address - Country:US
Practice Address - Phone:918-723-5466
Practice Address - Fax:918-723-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy