Healthcare Provider Details

I. General information

NPI: 1043956832
Provider Name (Legal Business Name): MIDTOWN DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 NW 11TH ST STE 112
OKLAHOMA CITY OK
73103-2405
US

IV. Provider business mailing address

525 NW 11TH ST STE 112
OKLAHOMA CITY OK
73103-2405
US

V. Phone/Fax

Practice location:
  • Phone: 405-768-1002
  • Fax: 888-626-6036
Mailing address:
  • Phone: 405-768-1002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. PHONG HOANG
Title or Position: OWNER/MANAGER
Credential: PHARMD
Phone: 405-768-1002