Provider Demographics
NPI:1912984188
Name:GLN OF ADA DOLLAR SAVER, INC
Entity Type:Organization
Organization Name:GLN OF ADA DOLLAR SAVER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-436-0900
Mailing Address - Street 1:1601 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-1403
Mailing Address - Country:US
Mailing Address - Phone:580-436-0900
Mailing Address - Fax:580-332-2541
Practice Address - Street 1:1601 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-1403
Practice Address - Country:US
Practice Address - Phone:580-436-0900
Practice Address - Fax:580-332-2541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23-4374333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3719296OtherNCPDP NUMBER
OK100242820AMedicaid