Healthcare Provider Details

I. General information

NPI: 1265598536
Provider Name (Legal Business Name): RX PRESCRIPTION SHOP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6517 S WESTERN AVE
OKLAHOMA CITY OK
73139-1705
US

IV. Provider business mailing address

6517 S WESTERN AVE
OKLAHOMA CITY OK
73139-1705
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-1415
  • Fax: 405-634-3527
Mailing address:
  • Phone: 405-634-1415
  • Fax: 405-634-3527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1-3867
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROSS MCALISTER
Title or Position: OWNER
Credential:
Phone: 405-634-1415