Healthcare Provider Details

I. General information

NPI: 1194818534
Provider Name (Legal Business Name): PHARM NICHOLS HILLS ACQUISITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N WESTERN AVE
NICHOLS HILLS OK
73116-7016
US

IV. Provider business mailing address

7600 N WESTERN AVE
NICHOLS HILLS OK
73116-7016
US

V. Phone/Fax

Practice location:
  • Phone: 405-843-9501
  • Fax: 405-842-8535
Mailing address:
  • Phone: 405-843-9501
  • Fax: 405-842-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1-7567
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW FINN
Title or Position: OFFICER
Credential:
Phone: 405-843-9501