Provider Demographics
NPI:1396164935
Name:PHYSICIANS & SURGEONS PHARMACY
Entity type:Organization
Organization Name:PHYSICIANS & SURGEONS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:STINNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-364-5222
Mailing Address - Street 1:900 N PORTER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6425
Mailing Address - Country:US
Mailing Address - Phone:405-364-5222
Mailing Address - Fax:405-364-7076
Practice Address - Street 1:900 N PORTER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6425
Practice Address - Country:US
Practice Address - Phone:405-364-5222
Practice Address - Fax:405-364-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7-17713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100234860AMedicaid
OK100234860AMedicaid