Baltro LLC
Organization Active NPI Community/Retail Pharmacy · Mannford, OK
NPI 1306909916 · NPPES record last updated Jul 14, 2015
Key facts
- NPI
- 1306909916
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 11-6040 (OK)
- Legal business name
- BALTRO LLC
- Practice address
- 124 Coonrod Ave
Mannford, OK 74044-3290 - Phone
- (918) 865-2164
- Fax
- (918) 865-7933
- NPI assigned
- Dec 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Willie Higgins
- Title
- Owner/Pharmacist
- Phone
- (918) 245-3791
Corporate family (same tax ID) 1
Practitioners 1
-
Bryan D Adams, DPH.
National Provider Directory
- Tax ID family
- Baltro LLC
Locations
124 Coonrod Ave
Mannford, OK 74044
Phone (918) 865-2164
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 11-6040 | OK | Yes |
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
124 Coonrod Ave
Mannford, OK 74044-3290
Mailing address
5828 S 170TH West Ave
Sand Springs, OK 74063-2312
Phone (918) 245-3791
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2137411 | Other | PK | |
| 200447810A | Medicaid | OK |
Other names
- Center Pharmacy
Other providers in Mannford, OK
- Bryan D Adams
- At Home Supplies
- Awesome Chiropractic Care
- Robert Duke Baker
- Baltro LLC
- Mikayla Rose Bullington
- CCPC, LLC
- City of Mannford
- Conhold of Mannford LLC
All providers in Mannford, 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 Jul 14, 2015. 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.