Provider Demographics
NPI:1780003475
Name:TEXOMA MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:TEXOMA MEDICAL SERVICES, INC
Other - Org Name:WESTERN DRUG #6
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DAILY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-256-8500
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:TALOGA
Mailing Address - State:OK
Mailing Address - Zip Code:73667-0236
Mailing Address - Country:US
Mailing Address - Phone:580-328-5208
Mailing Address - Fax:580-328-5211
Practice Address - Street 1:115 S HOY
Practice Address - Street 2:SUITE A
Practice Address - City:BUFFALO
Practice Address - State:OK
Practice Address - Zip Code:73834
Practice Address - Country:US
Practice Address - Phone:580-735-2277
Practice Address - Fax:580-735-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK112223336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100846370RMedicaid