Provider Demographics
NPI:1588939896
Name:PAWNEE DRUG, L.L.C.
Entity type:Organization
Organization Name:PAWNEE DRUG, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-208-1896
Mailing Address - Street 1:553 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74058-2566
Mailing Address - Country:US
Mailing Address - Phone:918-762-2148
Mailing Address - Fax:918-762-3717
Practice Address - Street 1:553 HARRISON ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-2566
Practice Address - Country:US
Practice Address - Phone:918-762-2148
Practice Address - Fax:918-762-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5226233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3726823OtherNCPDP PROVIDER IDENTIFICATION NUMBER