Provider Demographics
NPI:1154478212
Name:CYBER PHARMACY LLC
Entity Type:Organization
Organization Name:CYBER PHARMACY LLC
Other - Org Name:LEGEND CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOW
Authorized Official - Middle Name:
Authorized Official - Last Name:CLASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-321-5300
Mailing Address - Street 1:2600 TECHNOLOGY PL
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-1129
Mailing Address - Country:US
Mailing Address - Phone:405-321-5300
Mailing Address - Fax:405-321-5352
Practice Address - Street 1:2600 TECHNOLOGY PL
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-1129
Practice Address - Country:US
Practice Address - Phone:405-321-5300
Practice Address - Fax:405-321-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336I0012X, 3336M0003X, 3336S0011X
OK757673336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100246250AMedicaid
2076243OtherPK