Provider Demographics
NPI:1144305269
Name:SEMDRUG, LLC
Entity type:Organization
Organization Name:SEMDRUG, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KINCADE
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-808-3226
Mailing Address - Street 1:1717 N MILT PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-2333
Mailing Address - Country:US
Mailing Address - Phone:405-382-5420
Mailing Address - Fax:405-382-6146
Practice Address - Street 1:1717 N MILT PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-2333
Practice Address - Country:US
Practice Address - Phone:405-382-5420
Practice Address - Fax:405-382-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2073457OtherPK
OK100235950AMedicaid
2073457OtherPK