Healthcare Provider Details

I. General information

NPI: 1326975301
Provider Name (Legal Business Name): ANDY ESCOBEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NE 13TH ST STE 3840
OKLAHOMA CITY OK
73104-5040
US

IV. Provider business mailing address

9900 S MAY AVE APT 317
OKLAHOMA CITY OK
73159-9007
US

V. Phone/Fax

Practice location:
  • Phone: 572-244-6201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21100
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: