Healthcare Provider Details

I. General information

NPI: 1124382585
Provider Name (Legal Business Name): RX CONCEPTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2012
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7302 S YALE AVE STE 101
TULSA OK
74136-7027
US

IV. Provider business mailing address

7302 S YALE AVE STE 101
TULSA OK
74136-7027
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-3366
  • Fax: 918-392-2950
Mailing address:
  • Phone: 918-392-3366
  • Fax: 918-392-2950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-7788
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EDWARD OBANA
Title or Position: OWNER, AO
Credential: RPH
Phone: 918-392-3366