Provider Demographics
NPI:1306272778
Name:THUNDER DISCOUNT DRUG LLC
Entity type:Organization
Organization Name:THUNDER DISCOUNT DRUG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RORY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORINASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-212-3177
Mailing Address - Street 1:2296 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6462
Mailing Address - Country:US
Mailing Address - Phone:405-212-3177
Mailing Address - Fax:405-759-5593
Practice Address - Street 1:2296 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6462
Practice Address - Country:US
Practice Address - Phone:405-212-3177
Practice Address - Fax:405-759-5593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7-63693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200593020AMedicaid