Provider Demographics
NPI:1811553423
Name:SEQUOYAH COUNTY DRUG COMPANY PLLC
Entity Type:Organization
Organization Name:SEQUOYAH COUNTY DRUG COMPANY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:918-571-8813
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:
Mailing Address - City:WARNER
Mailing Address - State:OK
Mailing Address - Zip Code:74469-1130
Mailing Address - Country:US
Mailing Address - Phone:918-463-5444
Mailing Address - Fax:918-774-0890
Practice Address - Street 1:806 CAMPBELL RD STE B
Practice Address - Street 2:
Practice Address - City:WARNER
Practice Address - State:OK
Practice Address - Zip Code:74469-5008
Practice Address - Country:US
Practice Address - Phone:918-463-5444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy