Healthcare Provider Details

I. General information

NPI: 1871771436
Provider Name (Legal Business Name): KRISTI SUE PRESLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 COMMERCIAL AVE
MOUNDS OK
74047
US

IV. Provider business mailing address

PO BOX 32
MOUNDS OK
74047-0032
US

V. Phone/Fax

Practice location:
  • Phone: 918-827-6301
  • Fax: 918-827-6296
Mailing address:
  • Phone: 918-827-6301
  • Fax: 918-827-6296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11-5102
License Number StateOK

VIII. Authorized Official

Name: KRISTI PIOWATY
Title or Position: OWNER AND PHARMACIST
Credential: RPH
Phone: 918-827-6301