Healthcare Provider Details

I. General information

NPI: 1740426915
Provider Name (Legal Business Name): HOME CARE MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 NW 10TH ST
OKLAHOMA CITY OK
73103-3902
US

IV. Provider business mailing address

220 NW 10TH ST
OKLAHOMA CITY OK
73103-3902
US

V. Phone/Fax

Practice location:
  • Phone: 405-235-1468
  • Fax: 405-235-1476
Mailing address:
  • Phone: 405-235-1468
  • Fax: 405-235-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1-4589
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1-4589
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number1-4589
License Number StateOK

VIII. Authorized Official

Name: RAYMOND WILLINGHAM
Title or Position: CEO/OWNER
Credential:
Phone: 405-235-1468