Healthcare Provider Details

I. General information

NPI: 1619958592
Provider Name (Legal Business Name): OKULEYS PHARMACY AND HOME MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E 2ND ST
DEFIANCE OH
43512-2405
US

IV. Provider business mailing address

1201 E 2ND ST
DEFIANCE OH
43512-2405
US

V. Phone/Fax

Practice location:
  • Phone: 419-784-4800
  • Fax: 419-784-4777
Mailing address:
  • Phone: 419-784-4800
  • Fax: 419-784-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021184400
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIEU OKULEY
Title or Position: OWNER AND TREASURER
Credential: RPH
Phone: 419-784-4800