Provider Demographics
NPI:1790441897
Name:IMC NEIGHBORHOOD PHARMACY LLC
Entity Type:Organization
Organization Name:IMC NEIGHBORHOOD PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:FIDELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:IFEANYI ARIGUZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-576-6602
Mailing Address - Street 1:6333 E 120TH CT STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-8800
Mailing Address - Country:US
Mailing Address - Phone:918-576-6602
Mailing Address - Fax:
Practice Address - Street 1:6333 E 120TH CT STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-8800
Practice Address - Country:US
Practice Address - Phone:918-576-6602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMC NEIGHBORHOOD PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy