Healthcare Provider Details

I. General information

NPI: 1932679099
Provider Name (Legal Business Name): ZRC PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7158 NW 112TH ST
OKLAHOMA CITY OK
73162-2773
US

IV. Provider business mailing address

7158 NW 112TH ST
OKLAHOMA CITY OK
73162-2773
US

V. Phone/Fax

Practice location:
  • Phone: 405-470-7008
  • Fax: 405-470-1040
Mailing address:
  • Phone: 405-517-6104
  • 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: GREGORY CLYDE
Title or Position: MANAGING MEMBER
Credential: DPH
Phone: 405-517-6104