Provider Demographics
NPI:1538460795
Name:OK COMPOUNDING LLC
Entity Type:Organization
Organization Name:OK COMPOUNDING LLC
Other - Org Name:OK COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/MANAGING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-396-0100
Mailing Address - Street 1:102 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070
Mailing Address - Country:US
Mailing Address - Phone:918-396-0100
Mailing Address - Fax:918-396-0113
Practice Address - Street 1:102 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070
Practice Address - Country:US
Practice Address - Phone:918-396-0100
Practice Address - Fax:918-396-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2-61613336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139818OtherPK