Provider Demographics
NPI:1689751653
Name:OKULEYS PHARMACY INC.
Entity Type:Organization
Organization Name:OKULEYS PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER RPH
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIEU
Authorized Official - Middle Name:M
Authorized Official - Last Name:OKULEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-596-3898
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:102 S MAIN ST
Mailing Address - City:CONTINENTAL
Mailing Address - State:OH
Mailing Address - Zip Code:45831-9004
Mailing Address - Country:US
Mailing Address - Phone:419-596-3898
Mailing Address - Fax:419-596-3909
Practice Address - Street 1:102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CONTINENTAL
Practice Address - State:OH
Practice Address - Zip Code:45831-9004
Practice Address - Country:US
Practice Address - Phone:419-596-3898
Practice Address - Fax:419-596-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0209165003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0364681Medicaid
OH0364681Medicaid