Provider Demographics
NPI:1568555902
Name:TABORS DRUG INC
Entity Type:Organization
Organization Name:TABORS DRUG INC
Other - Org Name:TABORS DRUG INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TABOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:705-756-4511
Mailing Address - Street 1:225 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:OK
Mailing Address - Zip Code:73052-5633
Mailing Address - Country:US
Mailing Address - Phone:405-756-4511
Mailing Address - Fax:405-756-2861
Practice Address - Street 1:225 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052-5633
Practice Address - Country:US
Practice Address - Phone:405-756-4511
Practice Address - Fax:405-756-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
OK22-8713336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2072949OtherPK
OK100234080AMedicaid
OK100234080AMedicaid