Provider Demographics
NPI:1871255166
Name:CLAREMORE COMPOUNDING CENTER, INC
Entity Type:Organization
Organization Name:CLAREMORE COMPOUNDING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-283-3784
Mailing Address - Street 1:1000 W WILSHIRE BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7003
Mailing Address - Country:US
Mailing Address - Phone:405-754-1090
Mailing Address - Fax:405-594-6007
Practice Address - Street 1:1000 W WILSHIRE BLVD STE 401
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7003
Practice Address - Country:US
Practice Address - Phone:405-754-1090
Practice Address - Fax:405-594-6007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAREMORE COMPOUNDING CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1-9024OtherSTATE BOARD LICENSE
OK1-9024OtherSTATE BOARD LICENSE