Healthcare Provider Details

I. General information

NPI: 1649604356
Provider Name (Legal Business Name): PHARMCAREOK OF TULSA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S CHEROKEE ST STE B
CATOOSA OK
74015-2538
US

IV. Provider business mailing address

PO BOX 70
HYDRO OK
73048-0070
US

V. Phone/Fax

Practice location:
  • Phone: 918-379-0404
  • Fax: 888-228-0293
Mailing address:
  • Phone: 877-505-4111
  • Fax: 877-505-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number294408
License Number StateOK

VIII. Authorized Official

Name: KENT ABBOTT
Title or Position: PRESIDENT & CEO
Credential:
Phone: 877-505-4111