Provider Demographics
NPI:1982789038
Name:OKEMAH PHARMACY INC
Entity Type:Organization
Organization Name:OKEMAH PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRECH
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:918-623-2510
Mailing Address - Street 1:106 S WOODY GUTHRIE ST
Mailing Address - Street 2:
Mailing Address - City:OKEMAH
Mailing Address - State:OK
Mailing Address - Zip Code:74859-4047
Mailing Address - Country:US
Mailing Address - Phone:918-623-2510
Mailing Address - Fax:918-623-0319
Practice Address - Street 1:106 S WOODY GUTHRIE ST
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-4047
Practice Address - Country:US
Practice Address - Phone:918-623-2510
Practice Address - Fax:918-623-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
OK5144733336C0003X
OK50335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100234550AMedicaid
OK3709271Medicare UPIN
OK100234550AMedicaid
OK7481080001Medicare NSC