Provider Demographics
NPI:1124192653
Name:PHARMACY PROVIDERS INC
Entity Type:Organization
Organization Name:PHARMACY PROVIDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:918-376-0303
Mailing Address - Street 1:104 E 2ND AVE
Mailing Address - Street 2:STE B1
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-3127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 E 2ND AVE
Practice Address - Street 2:STE B1
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3127
Practice Address - Country:US
Practice Address - Phone:918-376-0303
Practice Address - Fax:918-272-2969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336H0001X
OK245193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3722394OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3722394OtherOTHER ID NUMBER-COMMERCIAL NUMBER