Healthcare Provider Details

I. General information

NPI: 1154478212
Provider Name (Legal Business Name): CYBER PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 TECHNOLOGY PL
NORMAN OK
73071-1129
US

IV. Provider business mailing address

2600 TECHNOLOGY PL
NORMAN OK
73071-1129
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-5300
  • Fax: 405-321-5352
Mailing address:
  • Phone: 405-321-5300
  • Fax: 405-321-5352

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 TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number75767
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DOW CLASSEN
Title or Position: PHARMACY MANAGER
Credential:
Phone: 405-321-5300