Healthcare Provider Details

I. General information

NPI: 1205227519
Provider Name (Legal Business Name): PRIME RX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 SW 44TH ST STE 700
OKLAHOMA CITY OK
73109-3618
US

IV. Provider business mailing address

2033 STERLING TRACE DR
KELLER TX
76248-9740
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-0519
  • Fax: 405-632-0503
Mailing address:
  • Phone: 972-489-6848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number16948
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAMELA NJIKAM
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 972-489-6848