Provider Demographics
NPI:1508102609
Name:INSYNC LIFE CARE LLC
Entity Type:Organization
Organization Name:INSYNC LIFE CARE LLC
Other - Org Name:INSYNC RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:AXSOM
Authorized Official - Suffix:
Authorized Official - Credentials:D PH
Authorized Official - Phone:918-582-7500
Mailing Address - Street 1:6310 EAST 102ND STREET
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7061
Mailing Address - Country:US
Mailing Address - Phone:918-582-7500
Mailing Address - Fax:918-728-2340
Practice Address - Street 1:6310 EAST 102ND STREET
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7061
Practice Address - Country:US
Practice Address - Phone:918-582-7500
Practice Address - Fax:918-728-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2-61323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200469640AMedicaid
OK2-6745OtherRX LICENSE NUMBER