Provider Demographics
NPI:1750583563
Name:OKLAHOMA CITY VAMC
Entity type:Organization
Organization Name:OKLAHOMA CITY VAMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NPI TEAM MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-382-2579
Mailing Address - Street 1:PO BOX 94537
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-4537
Mailing Address - Country:US
Mailing Address - Phone:913-578-4409
Mailing Address - Fax:
Practice Address - Street 1:4303 PITTMAN & THOMAS ROAD
Practice Address - Street 2:BLDG 4303
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-4473
Practice Address - Country:US
Practice Address - Phone:580-351-6511
Practice Address - Fax:580-351-6526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3723738OtherNCPDP