Healthcare Provider Details

I. General information

NPI: 1215671151
Provider Name (Legal Business Name): BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA DBA 1893 PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N STONEWALL AVE STE 1200
OKLAHOMA CITY OK
73117-1218
US

IV. Provider business mailing address

1110 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1200
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8931
  • Fax: 405-271-8938
Mailing address:
  • Phone: 405-550-5315
  • Fax: 405-271-6446

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 Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HENRY (JAY) W KINNARD JR.
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 405-550-5315