Provider Demographics
NPI:1275167074
Name:OKEMAH PHARMACY LLC
Entity Type:Organization
Organization Name:OKEMAH PHARMACY LLC
Other - Org Name:OKEMAH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-889-0230
Mailing Address - Street 1:744 S MISSISSIPPI AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-3356
Mailing Address - Country:US
Mailing Address - Phone:918-623-2510
Mailing Address - Fax:918-623-0319
Practice Address - Street 1:106 S WOODY GUTHRIE ST
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-4047
Practice Address - Country:US
Practice Address - Phone:918-623-2510
Practice Address - Fax:918-623-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy