Healthcare Provider Details

I. General information

NPI: 1053257998
Provider Name (Legal Business Name): EAGLET PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 SW 104TH ST STE E
OKLAHOMA CITY OK
73159-7551
US

IV. Provider business mailing address

2209 SW 104TH ST STE E
OKLAHOMA CITY OK
73159-7551
US

V. Phone/Fax

Practice location:
  • Phone: 800-407-7421
  • Fax: 800-308-8573
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: VALIMOHAMMED PANARA
Title or Position: MEMBER
Credential:
Phone: 405-676-5300