Provider Demographics
NPI:1134212566
Name:RELIABLE DISCOUNT PHARMACY INC
Entity type:Organization
Organization Name:RELIABLE DISCOUNT PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:SISEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:405-681-6631
Mailing Address - Street 1:5900 S PENNSYLVANIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-7029
Mailing Address - Country:US
Mailing Address - Phone:405-681-6631
Mailing Address - Fax:405-681-4425
Practice Address - Street 1:5900 S PENNSYLVANIA AVE STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7029
Practice Address - Country:US
Practice Address - Phone:405-681-6631
Practice Address - Fax:405-681-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK138933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100243320AMedicaid
OK90003927027Medicaid
2081577OtherPK
2081577OtherPK