Provider Demographics
NPI:1114392115
Name:REMEDI SENIORCARE OF OKLAHOMA LLC
Entity Type:Organization
Organization Name:REMEDI SENIORCARE OF OKLAHOMA LLC
Other - Org Name:REMEDI SENIORCARE OF OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, STRATEGIC SOURCING
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONFEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-927-8403
Mailing Address - Street 1:PO BOX 206329
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-6329
Mailing Address - Country:US
Mailing Address - Phone:443-927-8400
Mailing Address - Fax:443-927-8465
Practice Address - Street 1:4243 WILL ROGERS PKWY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-2039
Practice Address - Country:US
Practice Address - Phone:877-927-8713
Practice Address - Fax:855-240-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK1-75353336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200627500 AMedicaid
2155937OtherPK