Provider Demographics
NPI:1588779136
Name:RALLS ENTERPRISES INC
Entity type:Organization
Organization Name:RALLS ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:W A
Authorized Official - Middle Name:
Authorized Official - Last Name:RALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-286-2190
Mailing Address - Street 1:1200 SE LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-7358
Mailing Address - Country:US
Mailing Address - Phone:580-286-2190
Mailing Address - Fax:580-286-5260
Practice Address - Street 1:1200 SE LINCOLN RD
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7358
Practice Address - Country:US
Practice Address - Phone:580-286-2190
Practice Address - Fax:580-286-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25-43963336C0003X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2072937OtherPK
OK100241680AMedicaid