Healthcare Provider Details

I. General information

NPI: 1295216638
Provider Name (Legal Business Name): AUTARCH MEDICINAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E MAIN ST STE 100
CALERA OK
74730-2116
US

IV. Provider business mailing address

213 E MAIN ST STE 100
CALERA OK
74730-2116
US

V. Phone/Fax

Practice location:
  • Phone: 580-448-2315
  • Fax: 580-980-3015
Mailing address:
  • Phone: 580-448-2315
  • Fax: 580-980-3015

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number27-8253
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSIAH P SCHOMER
Title or Position: MEMBER
Credential: PHARMD
Phone: 580-448-2315