Healthcare Provider Details

I. General information

NPI: 1962842062
Provider Name (Legal Business Name): MEDCARE UNITED CHARITABLE PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 STANTON L YOUNG BLVD SUITE 100
OKLAHOMA CITY OK
73104-5023
US

IV. Provider business mailing address

711 STANTON L YOUNG BLVD SUITE 100
OKLAHOMA CITY OK
73104-5023
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6278
  • Fax: 405-271-6287
Mailing address:
  • Phone: 405-271-6278
  • Fax: 405-271-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number1-5412
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1-5412
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number1-5412
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number1-5412
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1-5412
License Number StateOK

VIII. Authorized Official

Name: TAMBERLYN HERD
Title or Position: PHARMACY DIRECTOR
Credential: RPH
Phone: 405-271-6278