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Contact Information

PRAGUE GROCERY, LLC
1000 W MAIN
3301 NBU
PRAGUE, OK74864
 Phone: 405-567-4000
 Fax: 405-567-4883
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for PRAGUE GROCERY, LLC

NPI Number 1306936836
LBN Legal business name PRAGUE GROCERY, LLC
Authorized official MELINDA FISHER - (PHARMACY MANAGER)
Entity Organization
Organization subpart 1 Yes
Enumeration date 10/13/2006
Last updated 08/11/2022 - About 4 years ago
Identifiers
OK License # 312129
OK Medicaid 100238090A
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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