Healthcare Provider Details

I. General information

NPI: 1013219096
Provider Name (Legal Business Name): OKULEYS PHARMACY & HOME MEDICAL OF WAUSEON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2010
Last Update Date: 11/24/2010
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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRTP022089450
License Number StateOH

VIII. Authorized Official

Name: KIEU OKULEY
Title or Position: PHARMACIST/OWNER
Credential: RPH
Phone: 419-596-2003