Provider Demographics
NPI:1154833796
Name:LIFE PHARMACY II
Entity Type:Organization
Organization Name:LIFE PHARMACY II
Other - Org Name:LIFE PHARMACY MIDTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHONARA
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-562-4242
Mailing Address - Street 1:1015 N SHARTEL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1032
Mailing Address - Country:US
Mailing Address - Phone:405-562-4242
Mailing Address - Fax:405-562-4535
Practice Address - Street 1:1015 N SHARTEL AVE STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1032
Practice Address - Country:US
Practice Address - Phone:405-562-4242
Practice Address - Fax:405-562-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy