Provider Demographics
NPI:1558024257
Name:TD PHARMACY SERVICES, PLLC
Entity Type:Organization
Organization Name:TD PHARMACY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:405-805-6191
Mailing Address - Street 1:3810 N. TULSA AVE.
Mailing Address - Street 2:STE H
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-805-6191
Mailing Address - Fax:
Practice Address - Street 1:3810 N. TULSA AVE.
Practice Address - Street 2:STE H
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-805-6191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy