Healthcare Provider Details

I. General information

NPI: 1811008550
Provider Name (Legal Business Name): OKULEYS PHARMACY AND HOME MEDICAL OF WAUSEON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S FULTON ST
WAUSEON OH
43567-1351
US

IV. Provider business mailing address

123 S FULTON ST
WAUSEON OH
43567-1351
US

V. Phone/Fax

Practice location:
  • Phone: 419-335-6901
  • Fax: 419-335-6901
Mailing address:
  • Phone: 419-335-6901
  • Fax: 419-335-6901

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 Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022089450
License Number StateOH

VIII. Authorized Official

Name: TRAVIS OKULEY
Title or Position: OWNER
Credential:
Phone: 419-596-2003