Healthcare Provider Details

I. General information

NPI: 1881024727
Provider Name (Legal Business Name): TULSA HILLS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6802 S OLYMPIA AVE STE 125
TULSA OK
74132-1823
US

IV. Provider business mailing address

6802 S OLYMPIA AVE STE 125
TULSA OK
74132-1823
US

V. Phone/Fax

Practice location:
  • Phone: 918-513-3234
  • Fax: 918-513-3229
Mailing address:
  • Phone: 918-513-3234
  • Fax: 918-513-3229

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 Number2-6487
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHAWN CRISMON
Title or Position: PHARMACY MANAGER
Credential:
Phone: 918-513-3234