Provider Demographics
NPI:1851812523
Name:OKULEYS PHARMACY INC.
Entity Type:Organization
Organization Name:OKULEYS PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LIANE
Authorized Official - Middle Name:JANIS
Authorized Official - Last Name:VIARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-784-4800
Mailing Address - Street 1:19384 ROAD B13
Mailing Address - Street 2:
Mailing Address - City:CONTINENTAL
Mailing Address - State:OH
Mailing Address - Zip Code:45831-9716
Mailing Address - Country:US
Mailing Address - Phone:419-956-7335
Mailing Address - Fax:
Practice Address - Street 1:102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CONTINENTAL
Practice Address - State:OH
Practice Address - Zip Code:45831-9194
Practice Address - Country:US
Practice Address - Phone:419-596-3898
Practice Address - Fax:419-596-3909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKULEY PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-03
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPMY.020916500-033336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0364681Medicaid