Healthcare Provider Details

I. General information

NPI: 1982789038
Provider Name (Legal Business Name): OKEMAH PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S WOODY GUTHRIE ST
OKEMAH OK
74859-4047
US

IV. Provider business mailing address

106 S WOODY GUTHRIE ST
OKEMAH OK
74859-4047
US

V. Phone/Fax

Practice location:
  • Phone: 918-623-2510
  • Fax: 918-623-0319
Mailing address:
  • Phone: 918-623-2510
  • Fax: 918-623-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number50
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number514473
License Number StateOK

VIII. Authorized Official

Name: MR. ELMER A FRECH
Title or Position: PRESIDENT
Credential: DPH
Phone: 918-623-2510