1033736657 NPI number — GENSCRIPTS GLENPOOL, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033736657 NPI number — GENSCRIPTS GLENPOOL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENSCRIPTS GLENPOOL, 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:
Provider Other Organization Name Type Code:
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:
1033736657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10827 S MEMORIAL DR STE I
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74133-7361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-921-8134
Provider Business Mailing Address Fax Number:
918-921-8134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12100 SOUTH YUKON AVENUE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GLENPOOL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-552-1040
Provider Business Practice Location Address Fax Number:
918-552-1030
Provider Enumeration Date:
06/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
POSTIER
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
PRESIDENT/COO
Authorized Official Telephone Number:
918-921-8134

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2-8643 . This is a "OKLAHOMA STATE BOARD OF PHARMACY : PHARMACY LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 76627 . This is a "OKLAHOMA BUREAU OF NARCOTICS AND DANGEROUS DRUGS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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