Provider Demographics
NPI:1285748277
Name:RED OAK DRUG INC
Entity type:Organization
Organization Name:RED OAK DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:972-938-2642
Mailing Address - Street 1:120 S GRAND AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2267
Mailing Address - Country:US
Mailing Address - Phone:972-938-2642
Mailing Address - Fax:972-937-5681
Practice Address - Street 1:120 S GRAND AVE
Practice Address - Street 2:STE 1
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2267
Practice Address - Country:US
Practice Address - Phone:972-938-2642
Practice Address - Fax:972-937-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
TX224443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2091167OtherPK
TX145265Medicaid
TX145265Medicaid