Provider Demographics
NPI:1215065594
Name:MEADOR DRUG
Entity type:Organization
Organization Name:MEADOR DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEADOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-526-3311
Mailing Address - Street 1:215 W ROGER MILLER BLVD
Mailing Address - Street 2:P.O.BOX 90
Mailing Address - City:ERICK
Mailing Address - State:OK
Mailing Address - Zip Code:73645-0090
Mailing Address - Country:US
Mailing Address - Phone:580-526-3311
Mailing Address - Fax:580-526-3275
Practice Address - Street 1:215 W ROGER MILLER BLVD
Practice Address - Street 2:
Practice Address - City:ERICK
Practice Address - State:OK
Practice Address - Zip Code:73645-0090
Practice Address - Country:US
Practice Address - Phone:580-526-3311
Practice Address - Fax:580-526-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35-2267333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3704928OtherNCPDP NUMBER
OK35-2267OtherOK ST BOARD PHARMACY NUMB
OK22131OtherOSBNDD NUMBER
OK239474OtherOK ST SALES TAX NUMBER
OK239474OtherOK ST SALES TAX NUMBER