Provider Demographics
NPI:1356348478
Name:CENTRAL DRUG STORE, INC.
Entity type:Organization
Organization Name:CENTRAL DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-489-3521
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:CEMENT
Mailing Address - State:OK
Mailing Address - Zip Code:73017-0300
Mailing Address - Country:US
Mailing Address - Phone:405-489-3521
Mailing Address - Fax:405-489-3521
Practice Address - Street 1:307 NORTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:CEMENT
Practice Address - State:OK
Practice Address - Zip Code:73017-0300
Practice Address - Country:US
Practice Address - Phone:405-489-3521
Practice Address - Fax:405-489-3521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20-2778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty