Healthcare Provider Details

I. General information

NPI: 1598766263
Provider Name (Legal Business Name): SAFFA HEALTHMART PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8002 S SHERIDAN RD
TULSA OK
74133-8945
US

IV. Provider business mailing address

8002 S SHERIDAN RD
TULSA OK
74133-8945
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-4242
  • Fax: 918-493-5790
Mailing address:
  • Phone: 918-492-4242
  • Fax: 918-493-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number24513
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number24513
License Number StateOK

VIII. Authorized Official

Name: DEBRA L WELLS
Title or Position: STORE MANAGER
Credential:
Phone: 918-492-4242