Healthcare Provider Details

I. General information

NPI: 1508221854
Provider Name (Legal Business Name): CAREFIRST PHARMACY TULSA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6214 S SHERIDAN RD
TULSA OK
74133-4055
US

IV. Provider business mailing address

2530 N ELM PL
BROKEN ARROW OK
74012-1285
US

V. Phone/Fax

Practice location:
  • Phone: 918-940-6767
  • Fax: 918-940-6497
Mailing address:
  • Phone: 918-940-6767
  • Fax: 918-940-6497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-7490
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MARTI
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 918-940-6767