Provider Demographics
NPI:1700177904
Name:RAZOOKS PHARMACY LLC
Entity Type:Organization
Organization Name:RAZOOKS PHARMACY LLC
Other - Org Name:RAZOOK'S DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HLADIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-377-4445
Mailing Address - Street 1:1518 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-5468
Mailing Address - Country:US
Mailing Address - Phone:405-377-4445
Mailing Address - Fax:405-377-4448
Practice Address - Street 1:1518 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5468
Practice Address - Country:US
Practice Address - Phone:405-377-4445
Practice Address - Fax:405-377-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336S0011X
OK8-56373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130000OtherPK
OK200332970AMedicaid