1306167572 NPI number — BFL MLK LLC

Table of content: (NPI 1306167572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306167572 NPI number — BFL MLK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BFL MLK LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BUY FOR LESS PHARMACY #2001
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306167572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2129 W HEFNER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73120-7601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-302-6273
Provider Business Mailing Address Fax Number:
405-302-0385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 NE 23RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73111-3401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-424-4361
Provider Business Practice Location Address Fax Number:
405-424-4362
Provider Enumeration Date:
06/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BECKWITH
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
405-302-6282

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 15536 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3726277 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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