Provider Demographics
NPI:1891398061
Name:EXPRESS DRUG LLC
Entity Type:Organization
Organization Name:EXPRESS DRUG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:405-735-3950
Mailing Address - Street 1:12032 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5910
Mailing Address - Country:US
Mailing Address - Phone:405-735-3950
Mailing Address - Fax:405-735-6079
Practice Address - Street 1:12032 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-5910
Practice Address - Country:US
Practice Address - Phone:405-735-3950
Practice Address - Fax:405-735-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200465600AMedicaid