Healthcare Provider Details

I. General information

NPI: 1003382060
Provider Name (Legal Business Name): CAREFIRST PHARMACY TULSA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6214 S. SHERIDAN RD
TULSA OK
74133
US

IV. Provider business mailing address

2530 N ELM PL.
BROKEN ARROW OK
74012
US

V. Phone/Fax

Practice location:
  • Phone: 918-940-6767
  • Fax: 918-940-6497
Mailing address:
  • Phone: 918-994-1400
  • Fax: 918-994-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: THOMAS J MARTI
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 918-994-1400