1215671151 NPI number — BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA DBA 1893 PHARMACY

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 1215671151 NPI number — BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA DBA 1893 PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA DBA 1893 PHARMACY
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:
6
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:
1215671151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 N STONEWALL AVE
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:
73117-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-550-5315
Provider Business Mailing Address Fax Number:
405-271-6446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 N STONEWALL AVE STE 1200
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:
73117-1218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-271-8931
Provider Business Practice Location Address Fax Number:
405-271-8938
Provider Enumeration Date:
04/26/2022

Additional Information

Authorized Official

Authorized Official Last Name:
KINNARD
Authorized Official First Name:
HENRY (JAY)
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
405-550-5315

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X ; 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)





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