1720017437 NPI number — PHARMCAREOK OF TULSA, INC.

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 1720017437 NPI number — PHARMCAREOK OF TULSA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMCAREOK OF TULSA, 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:
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:
1720017437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYDRO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73048-0070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-379-0404
Provider Business Mailing Address Fax Number:
877-505-7999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2760 N S HIGHWAY 167
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATOOSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-379-0404
Provider Business Practice Location Address Fax Number:
877-505-7999
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABBOTT
Authorized Official First Name:
BARNEY
Authorized Official Middle Name:
KENT
Authorized Official Title or Position:
PRES CEO
Authorized Official Telephone Number:
405-663-4111

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  294408 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100246040A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3722306 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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