Provider Demographics
NPI:1033736657
Name:GENSCRIPTS GLENPOOL, LLC
Entity Type:Organization
Organization Name:GENSCRIPTS GLENPOOL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:POSTIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:918-921-8134
Mailing Address - Street 1:10827 S MEMORIAL DR STE I
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7361
Mailing Address - Country:US
Mailing Address - Phone:918-921-8134
Mailing Address - Fax:918-921-8134
Practice Address - Street 1:12100 SOUTH YUKON AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033
Practice Address - Country:US
Practice Address - Phone:918-552-1040
Practice Address - Fax:918-552-1030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENSCRIPTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2-8643OtherOKLAHOMA STATE BOARD OF PHARMACY : PHARMACY LICENSE
OK76627OtherOKLAHOMA BUREAU OF NARCOTICS AND DANGEROUS DRUGS