Provider Demographics
NPI:1134490550
Name:DAVES HEALTHMART PHARMACY INC
Entity Type:Organization
Organization Name:DAVES HEALTHMART PHARMACY INC
Other - Org Name:DAVE'S HEALTHMART PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PIC
Authorized Official - Prefix:
Authorized Official - First Name:DIVYESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-514-7419
Mailing Address - Street 1:329 N PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-5838
Mailing Address - Country:US
Mailing Address - Phone:405-360-8882
Mailing Address - Fax:405-360-3154
Practice Address - Street 1:329 N PORTER AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5838
Practice Address - Country:US
Practice Address - Phone:405-360-8882
Practice Address - Fax:405-360-3154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
OK758503336C0003X, 3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200418650AMedicaid
2133440OtherPK