Healthcare Provider Details

I. General information

NPI: 1760810071
Provider Name (Legal Business Name): BROOKHAVEN SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 W ROBINSON ST SUITE 150
NORMAN OK
73072-3660
US

IV. Provider business mailing address

5874 S MINGO RD
TULSA OK
74146-6425
US

V. Phone/Fax

Practice location:
  • Phone: 580-421-6929
  • Fax:
Mailing address:
  • Phone: 918-695-0167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number7-6445
License Number StateOK

VIII. Authorized Official

Name: MRS. KRISTY LAUREN DAVIS
Title or Position: PHARMACIST/PIC
Credential: PHARMD
Phone: 405-801-4100