Provider Demographics
NPI:1639592330
Name:CHEROKEE HILLS DRUG COMPANY LLC
Entity Type:Organization
Organization Name:CHEROKEE HILLS DRUG COMPANY LLC
Other - Org Name:CHEROKEE HILLS PHARMACY
Other - Org Type:Doing Business As
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:918-456-2531
Mailing Address - Street 1:1607 S MUSKOGEE AVE
Mailing Address - Street 2:STE D
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5440
Mailing Address - Country:US
Mailing Address - Phone:918-456-2531
Mailing Address - Fax:918-456-2586
Practice Address - Street 1:1607 S MUSKOGEE AVE
Practice Address - Street 2:STE D
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5440
Practice Address - Country:US
Practice Address - Phone:918-456-2531
Practice Address - Fax:918-456-2586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy