Healthcare Provider Details

I. General information

NPI: 1649441387
Provider Name (Legal Business Name): ALL SAINTS HOME MEDICAL, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11212 E. 48TH ST
TULSA OK
74146
US

IV. Provider business mailing address

11212 E. 48TH ST
TULSA OK
74146
US

V. Phone/Fax

Practice location:
  • Phone: 918-556-7127
  • Fax: 918-556-7067
Mailing address:
  • Phone: 918-556-7127
  • Fax: 918-556-7067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-6800
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number2-6800
License Number StateOK

VIII. Authorized Official

Name: JAY TIPPS
Title or Position: DIRECTOR
Credential:
Phone: 918-488-6660