Healthcare Provider Details

I. General information

NPI: 1972221018
Provider Name (Legal Business Name): MARK STEWART FAIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 ALAMEDA ST
NORMAN OK
73071-5229
US

IV. Provider business mailing address

112 HOUSTON AVE
PERRYVILLE AR
72126-9451
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-6783
  • Fax:
Mailing address:
  • Phone: 501-889-5111
  • Fax: 501-889-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD14636
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: