Provider Demographics
NPI:1750527925
Name:HENRY ROBERTS EXPRESS PHARMACY LLC
Entity type:Organization
Organization Name:HENRY ROBERTS EXPRESS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-226-2684
Mailing Address - Street 1:1306 12TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1285
Mailing Address - Country:US
Mailing Address - Phone:580-226-2684
Mailing Address - Fax:580-226-3902
Practice Address - Street 1:1306 12TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1285
Practice Address - Country:US
Practice Address - Phone:580-226-2684
Practice Address - Fax:580-226-3902
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRY ROBERTS EXPRESS PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12-41843336C0003X, 3336H0001X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy