Provider Demographics
NPI:1861510083
Name:RALPHS DRUG & TAG AGENCY
Entity Type:Organization
Organization Name:RALPHS DRUG & TAG AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:DIMONICO
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-634-3317
Mailing Address - Street 1:1301 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-2301
Mailing Address - Country:US
Mailing Address - Phone:405-634-3317
Mailing Address - Fax:405-634-3317
Practice Address - Street 1:1301 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-2301
Practice Address - Country:US
Practice Address - Phone:405-634-3317
Practice Address - Fax:405-634-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7139183500000X
OK11466333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Not Answered333600000XSuppliersPharmacy