Healthcare Provider Details

I. General information

NPI: 1386683761
Provider Name (Legal Business Name): WENJEST CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 NW 122ND ST
OKLAHOMA CITY OK
73142-3924
US

IV. Provider business mailing address

7001 NW 122ND ST
OKLAHOMA CITY OK
73142-3924
US

V. Phone/Fax

Practice location:
  • Phone: 405-720-9303
  • Fax: 405-720-6317
Mailing address:
  • Phone: 405-720-9303
  • Fax: 405-720-6317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1-5212
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JULIE WILLIS
Title or Position: PHARMACY SUPERVISOR
Credential: RPH
Phone: 405-473-0094