Healthcare Provider Details

I. General information

NPI: 1255354650
Provider Name (Legal Business Name): BOARD OF REGENTS OF THE UNIV OF OKLAHOMA PHARMACISTS MED MGMNT SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1200
US

IV. Provider business mailing address

PO BOX 26901
OKLAHOMA CITY OK
73190-0001
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6485
  • Fax: 405-271-3830
Mailing address:
  • Phone: 405-271-6485
  • Fax: 405-271-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number State

VIII. Authorized Official

Name: JAMIE JILL SHADID
Title or Position: DIRECTOR OF PHARMACY OPERATIONS
Credential: RPH, MBA
Phone: 405-271-6878