Provider Demographics
NPI:1871213280
Name:R&S DRUG STORE #3 LLC
Entity type:Organization
Organization Name:R&S DRUG STORE #3 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLEE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-252-0140
Mailing Address - Street 1:3117 N HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-9283
Mailing Address - Country:US
Mailing Address - Phone:580-252-0140
Mailing Address - Fax:580-252-0143
Practice Address - Street 1:3117 N HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-9283
Practice Address - Country:US
Practice Address - Phone:580-252-0140
Practice Address - Fax:580-252-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200686460AMedicaid
OK200686460BMedicaid