Provider Demographics
NPI:1881917086
Name:WINDSOR PARK PHARMACY OF OKLAHOMA LLC
Entity type:Organization
Organization Name:WINDSOR PARK PHARMACY OF OKLAHOMA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-702-4747
Mailing Address - Street 1:2506 N MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1035
Mailing Address - Country:US
Mailing Address - Phone:405-702-4747
Mailing Address - Fax:
Practice Address - Street 1:2506 N MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-1035
Practice Address - Country:US
Practice Address - Phone:405-702-4747
Practice Address - Fax:405-702-4765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
OK16662333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124016OtherPK
OK200282310AMedicaid