Provider Demographics
NPI:1649304353
Name:OAKS PHARMACY INC
Entity type:Organization
Organization Name:OAKS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-465-1414
Mailing Address - Street 1:1401 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-5948
Mailing Address - Country:US
Mailing Address - Phone:215-465-1414
Mailing Address - Fax:215-465-6047
Practice Address - Street 1:1401 S 4TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-5948
Practice Address - Country:US
Practice Address - Phone:215-465-1414
Practice Address - Fax:215-465-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP415254L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001620421Medicaid
3972646OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PA0001620421Medicaid