Provider Demographics
NPI:1457983595
Name:COMMUNITY HEALTH CONNECTION INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CONNECTION INC
Other - Org Name:COMMUNITY HEALTH CONNECTION PHARMACY - ELLEN OCHOA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-622-0641
Mailing Address - Street 1:2321 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-1831
Mailing Address - Country:US
Mailing Address - Phone:918-710-4460
Mailing Address - Fax:918-710-4461
Practice Address - Street 1:12020 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-7401
Practice Address - Country:US
Practice Address - Phone:918-710-4460
Practice Address - Fax:918-710-4461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CONNECTION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-06
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200082520FMedicaid