Healthcare Provider Details

I. General information

NPI: 1992641815
Provider Name (Legal Business Name): INA MAHONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 NW 23RD ST
OKLAHOMA CITY OK
73103-1515
US

IV. Provider business mailing address

14025 N EASTERN AVE APT 3002
EDMOND OK
73013-3521
US

V. Phone/Fax

Practice location:
  • Phone: 405-415-3852
  • Fax:
Mailing address:
  • Phone: 405-922-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberI-10754
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: