Healthcare Provider Details

I. General information

NPI: 1124100920
Provider Name (Legal Business Name): WENJOE APOTHECARY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 W WILL ROGERS BLVD
CLAREMORE OK
74017-5417
US

IV. Provider business mailing address

998 W WILL ROGERS BLVD
CLAREMORE OK
74017-5417
US

V. Phone/Fax

Practice location:
  • Phone: 918-341-1184
  • Fax: 918-341-6800
Mailing address:
  • Phone: 918-341-1184
  • Fax: 918-341-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOE FORCUM
Title or Position: OWNER
Credential:
Phone: 918-576-8186