Provider Demographics
NPI:1174692339
Name:RHOADS BROTHERS PHARMACIES, INC.
Entity type:Organization
Organization Name:RHOADS BROTHERS PHARMACIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:RHOADS
Authorized Official - Suffix:I
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-362-2420
Mailing Address - Street 1:106 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWKIRK
Mailing Address - State:OK
Mailing Address - Zip Code:74647-4012
Mailing Address - Country:US
Mailing Address - Phone:580-362-2420
Mailing Address - Fax:580-362-2462
Practice Address - Street 1:106 W 7TH ST
Practice Address - Street 2:
Practice Address - City:NEWKIRK
Practice Address - State:OK
Practice Address - Zip Code:74647-4012
Practice Address - Country:US
Practice Address - Phone:580-362-2420
Practice Address - Fax:580-362-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3720299OtherNABP