Provider Demographics
NPI:1437433448
Name:HARVARD FAMILY PHYSICIANS P C
Entity Type:Organization
Organization Name:HARVARD FAMILY PHYSICIANS P C
Other - Org Name:HARVARD FAMILY PHYSICIANS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:FRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:918-728-7654
Mailing Address - Street 1:7912 E 31ST CT
Mailing Address - Street 2:STE 130
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1315
Mailing Address - Country:US
Mailing Address - Phone:918-728-7654
Mailing Address - Fax:918-728-7655
Practice Address - Street 1:7912 E 31ST CT STE 130
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1346
Practice Address - Country:US
Practice Address - Phone:918-728-7654
Practice Address - Fax:918-728-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK2-57913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100740300CMedicaid
2132243OtherPK