Provider Demographics
NPI:1649602293
Name:SSM HEALTH CARE OF OKLAHOMA INC
Entity Type:Organization
Organization Name:SSM HEALTH CARE OF OKLAHOMA INC
Other - Org Name:SSM HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL VP - FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SHASTA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-272-7279
Mailing Address - Street 1:608 NW 9TH ST
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1068
Mailing Address - Country:US
Mailing Address - Phone:405-815-5655
Mailing Address - Fax:
Practice Address - Street 1:608 NW 9TH ST
Practice Address - Street 2:SUITE 3200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102
Practice Address - Country:US
Practice Address - Phone:405-815-5655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-06
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK162813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy