Provider Demographics
NPI:1821472739
Name:PARENTS INVESTMENT CORPORATION
Entity Type:Organization
Organization Name:PARENTS INVESTMENT CORPORATION
Other - Org Name:BRATTON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-782-2195
Mailing Address - Street 1:109 S OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-4219
Mailing Address - Country:US
Mailing Address - Phone:580-782-2195
Mailing Address - Fax:580-782-3485
Practice Address - Street 1:109 S OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-4219
Practice Address - Country:US
Practice Address - Phone:580-782-2195
Practice Address - Fax:580-782-3485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
OK60-73753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153943OtherPK
OK200609980AMedicaid