Provider Demographics
NPI:1205227519
Name:PRIME RX PHARMACY LLC
Entity Type:Organization
Organization Name:PRIME RX PHARMACY LLC
Other - Org Name:PRIME RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:NJIKAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-489-6848
Mailing Address - Street 1:2033 STERLING TRACE DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-9740
Mailing Address - Country:US
Mailing Address - Phone:972-489-6848
Mailing Address - Fax:
Practice Address - Street 1:1024 SW 44TH ST STE 700
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3618
Practice Address - Country:US
Practice Address - Phone:405-632-0519
Practice Address - Fax:405-632-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X, 3336L0003X, 3336M0002X
OK169483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150454OtherPK