1750598066 NPI number — HUNTERS PRECISION RX LLC

Table of content: (NPI 1750598066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750598066 NPI number — HUNTERS PRECISION RX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTERS PRECISION RX 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:
PRECISION RX
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:
1750598066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10120 BROADWAY EXTENSION
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-418-2929
Provider Business Mailing Address Fax Number:
405-418-2766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10120 BROADWAY EXTENSION
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73114-7311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-418-2929
Provider Business Practice Location Address Fax Number:
405-418-2766
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUNTER
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-418-2929

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  OS02328 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 1-7403 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 167317407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0202328 . This is a "STATE LICENSE AR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1-8983 . This is a "OK STATE BOARD OF PHARMACY" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200116560-A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35759 . This is a "OBNDD - BUREAU OF NARCOTICS OK" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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