Healthcare Provider Details

I. General information

NPI: 1134490550
Provider Name (Legal Business Name): DAVES HEALTHMART PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 N PORTER AVE
NORMAN OK
73071-5838
US

IV. Provider business mailing address

329 N PORTER AVE
NORMAN OK
73071-5838
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-8882
  • Fax: 405-360-3154
Mailing address:
  • Phone: 405-360-8882
  • Fax: 405-360-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number75850
License Number StateOK

VIII. Authorized Official

Name: DIVYESH PATEL
Title or Position: CEO/PIC
Credential:
Phone: 405-514-7419