Provider Demographics
NPI:1932459666
Name:PROVIDENCE DRUGS LLC
Entity Type:Organization
Organization Name:PROVIDENCE DRUGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:KENECHUKWU
Authorized Official - Last Name:OKELU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-353-7202
Mailing Address - Street 1:8877 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-1715
Mailing Address - Country:US
Mailing Address - Phone:214-353-7202
Mailing Address - Fax:214-353-7203
Practice Address - Street 1:8877 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-1715
Practice Address - Country:US
Practice Address - Phone:214-353-7202
Practice Address - Fax:214-353-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy