Healthcare Provider Details

I. General information

NPI: 1619052909
Provider Name (Legal Business Name): MEDIC PHARMACY MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 N PORTLAND AVE
OKLAHOMA CITY OK
73112-1678
US

IV. Provider business mailing address

5701 N PORTLAND AVE
OKLAHOMA CITY OK
73112-1678
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-6410
  • Fax: 405-949-6412
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number13564
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RHONDA COTHRAN
Title or Position: MANAGER
Credential: PHARMACIST
Phone: 405-949-6410