Provider Demographics
NPI:1629377064
Name:CENTRAL DRUG LLC
Entity Type:Organization
Organization Name:CENTRAL DRUG LLC
Other - Org Name:CEMENT DRUG LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBREATH JR.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-224-2858
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:CEMENT
Mailing Address - State:OK
Mailing Address - Zip Code:73017-0300
Mailing Address - Country:US
Mailing Address - Phone:405-489-3521
Mailing Address - Fax:405-489-3521
Practice Address - Street 1:307 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEMENT
Practice Address - State:OK
Practice Address - Zip Code:73017-0300
Practice Address - Country:US
Practice Address - Phone:405-489-3521
Practice Address - Fax:405-489-3521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20-56543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130561OtherPK