Healthcare Provider Details

I. General information

NPI: 1881917086
Provider Name (Legal Business Name): WINDSOR PARK PHARMACY OF OKLAHOMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 N MERIDIAN AVE
OKLAHOMA CITY OK
73107-1035
US

IV. Provider business mailing address

2506 N MERIDIAN AVE
OKLAHOMA CITY OK
73107-1035
US

V. Phone/Fax

Practice location:
  • Phone: 405-702-4747
  • Fax: 405-702-4765
Mailing address:
  • Phone: 405-702-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number16662
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOAN GUINN
Title or Position: PHARMACIST/MANAGER
Credential:
Phone: 405-702-4747