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Contact Information

EDREI, LLC.
1721 W 6TH AVE
STILLWATER, OK74074-4200
 Phone: 405-372-3331
 Fax: 405-372-3547
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for EDREI, LLC.

NPI Number 1053418996
LBN Legal business name EDREI, LLC.
Authorized official LISA HLADIK - (MEMBER/MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 09/20/2006
Last updated 12/02/2021 - About 5 years ago
Identifiers
OK License # 83581
OK Medicaid 200725050A
Other 2074050 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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