Healthcare Provider Details

I. General information

NPI: 1922182062
Provider Name (Legal Business Name): MEDX CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 S HARVARD AVE
TULSA OK
74135-4402
US

IV. Provider business mailing address

2100 BROOKWOOD DR
LITTLE ROCK AR
72202-1734
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-6226
  • Fax: 918-743-1495
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number21107
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number21107
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOYCE STROM
Title or Position: RETAIL SUPPORT
Credential:
Phone: 501-296-3312