Provider Demographics
NPI:1982797320
Name:BARLOWS DRUG AND GIFTS INC
Entity Type:Organization
Organization Name:BARLOWS DRUG AND GIFTS INC
Other - Org Name:FAIRFAX HEALTH MART DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:918-642-3318
Mailing Address - Street 1:249 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:OK
Mailing Address - Zip Code:74637-3024
Mailing Address - Country:US
Mailing Address - Phone:918-642-3318
Mailing Address - Fax:918-642-3447
Practice Address - Street 1:249 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:OK
Practice Address - Zip Code:74637-3024
Practice Address - Country:US
Practice Address - Phone:918-642-3318
Practice Address - Fax:918-642-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
OK1649083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100240470AMedicaid
2074297OtherPK