Healthcare Provider Details

I. General information

NPI: 1124049192
Provider Name (Legal Business Name): FMC PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 S HARVARD AVE STE 400
TULSA OK
74114-3300
US

IV. Provider business mailing address

LOCK BOX DEPT 2113
TULSA OK
74182-0001
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-3407
  • Fax: 918-712-3408
Mailing address:
  • Phone: 918-712-3407
  • Fax: 918-712-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number2-4962
License Number StateOK

VIII. Authorized Official

Name: LISA OWENS
Title or Position: PIC
Credential: DPH
Phone: 918-712-3407