Healthcare Provider Details

I. General information

NPI: 1124192653
Provider Name (Legal Business Name): PHARMACY PROVIDERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E 2ND AVE STE B1
OWASSO OK
74055-3127
US

IV. Provider business mailing address

104 E 2ND AVE STE B1
OWASSO OK
74055-3127
US

V. Phone/Fax

Practice location:
  • Phone: 918-376-0303
  • Fax: 918-272-2969
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number24519
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROGER THOMPSON
Title or Position: PRESIDENT
Credential: DPH
Phone: 918-376-0303