Provider Demographics
NPI:1861854713
Name:AFFORDABLE PHARMACY AND HEALTH FOOD CENTER LLC
Entity Type:Organization
Organization Name:AFFORDABLE PHARMACY AND HEALTH FOOD CENTER LLC
Other - Org Name:AFFORDABLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:I
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-636-4091
Mailing Address - Street 1:2636 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-5823
Mailing Address - Country:US
Mailing Address - Phone:405-636-4091
Mailing Address - Fax:405-353-7023
Practice Address - Street 1:2636 SW 28TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-5823
Practice Address - Country:US
Practice Address - Phone:405-636-4091
Practice Address - Fax:405-353-7023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-21
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK178483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200639500AMedicaid
2158653OtherPK