Provider Demographics
NPI:1790471407
Name:DIVERSITY FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:DIVERSITY FAMILY PHARMACY INC
Other - Org Name:DIVERSITY FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:QAIUUM
Authorized Official - Middle Name:
Authorized Official - Last Name:FEROZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-778-6820
Mailing Address - Street 1:1211 N SHARTEL AVE STE 300A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2425
Mailing Address - Country:US
Mailing Address - Phone:405-778-6820
Mailing Address - Fax:405-778-6825
Practice Address - Street 1:1211 N SHARTEL AVE STE 300A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2425
Practice Address - Country:US
Practice Address - Phone:405-778-6820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy