Healthcare Provider Details

I. General information

NPI: 1043854300
Provider Name (Legal Business Name): PAHL PHARMACEUTICAL PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 NW 58TH ST STE 850E
OKLAHOMA CITY OK
73112-4804
US

IV. Provider business mailing address

3535 NW 58TH ST STE 850E
OKLAHOMA CITY OK
73112-4804
US

V. Phone/Fax

Practice location:
  • Phone: 405-525-2222
  • Fax: 405-525-9800
Mailing address:
  • Phone: 405-525-2222
  • Fax: 405-525-9800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK A PAHL
Title or Position: CEO
Credential:
Phone: 405-525-2222