Provider Demographics
NPI:1619958592
Name:OKULEYS PHARMACY AND HOME MEDICAL INC
Entity Type:Organization
Organization Name:OKULEYS PHARMACY AND HOME MEDICAL INC
Other - Org Name:OKULEYS PHARMACY AND HOME MEDICAL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KIEU
Authorized Official - Middle Name:
Authorized Official - Last Name:OKULEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-784-4800
Mailing Address - Street 1:1201 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2405
Mailing Address - Country:US
Mailing Address - Phone:419-784-4800
Mailing Address - Fax:419-784-4777
Practice Address - Street 1:1201 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2405
Practice Address - Country:US
Practice Address - Phone:419-784-4800
Practice Address - Fax:419-784-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
OH0211844003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2077524OtherPK
OH2331499Medicaid
OH2331499Medicaid