Kidd Healthmart Drug Co
Organization Active NPI Community/Retail Pharmacy · Fairview, OK
NPI 1295880185 · NPPES record last updated Feb 20, 2017
Key facts
- NPI
- 1295880185
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 66-2590 (OK)
- Legal business name
- KIDD HEALTHMART DRUG CO
- Practice address
- 104 N Main St
Fairview, OK 73737-1621 - Phone
- (580) 227-4685
- Fax
- (580) 227-2351
- NPI assigned
- Jan 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Susan Kidd Martens
- Title
- President
- Phone
- (580) 227-4685
National Provider Directory
Locations
104 N Main St
Fairview, OK 73737
Phone (580) 227-4685
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 66-2590 | OK | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
104 N Main St
Fairview, OK 73737-1621
Mailing address
104 N Main St
Fairview, OK 73737-1621
Phone (580) 227-4685
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2072788 | Other | PK | |
| 100237780A | Medicaid | OK |
Other names
- KIDD DRUGS GIFT INC
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All providers in Fairview, OK · Community/Retail Pharmacy in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.