Provider Demographics
NPI:1215448337
Name:1ST CHOICE PHARMACY LLC
Entity type:Organization
Organization Name:1ST CHOICE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:NGOZIKA
Authorized Official - Middle Name:GEORGIA
Authorized Official - Last Name:OSOSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-590-2469
Mailing Address - Street 1:1024 NW 47TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-6403
Mailing Address - Country:US
Mailing Address - Phone:405-509-2469
Mailing Address - Fax:405-513-5971
Practice Address - Street 1:1024 NW 47TH ST STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-6403
Practice Address - Country:US
Practice Address - Phone:405-509-2469
Practice Address - Fax:405-513-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2174115OtherPK
OK200744830AMedicaid
OK200744830Medicaid