Provider Demographics
NPI:1639518038
Name:CREATIVE CARE PHARMACY, LLC
Entity Type:Organization
Organization Name:CREATIVE CARE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:405-562-1800
Mailing Address - Street 1:14101 N EASTERN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5859
Mailing Address - Country:US
Mailing Address - Phone:405-562-1800
Mailing Address - Fax:405-562-1880
Practice Address - Street 1:14101 N EASTERN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5859
Practice Address - Country:US
Practice Address - Phone:405-562-1800
Practice Address - Fax:405-562-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200494830AMedicaid