Healthcare Provider Details

I. General information

NPI: 1902918915
Provider Name (Legal Business Name): OKLAHOMA COUNTY CLINIC PHCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 NE 23RD ST
OKLAHOMA CITY OK
73141-1420
US

IV. Provider business mailing address

7401 NE 23RD ST
OKLAHOMA CITY OK
73141-1420
US

V. Phone/Fax

Practice location:
  • Phone: 405-278-1891
  • Fax: 405-713-6518
Mailing address:
  • Phone: 405-278-1891
  • Fax: 405-713-6518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number13539
License Number StateOK

VIII. Authorized Official

Name: DENNIS CLICK
Title or Position: CHIEF PHARMACIST
Credential: RPH
Phone: 405-713-1891