1487758447 NPI number — TAYLOR DRUG OPERATING SERVICES INC

Table of content: (NPI 1487758447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487758447 NPI number — TAYLOR DRUG OPERATING SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAYLOR DRUG OPERATING SERVICES INC
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:
1487758447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11317 S WESTERN AVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73170-5849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-616-1941
Provider Business Mailing Address Fax Number:
405-616-1946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11317 S WESTERN AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73170-5849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-616-1941
Provider Business Practice Location Address Fax Number:
405-616-1946
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
FRED
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
620-442-3500

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  7-6374 , 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: 100247440B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100247440A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2076452 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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