Healthcare Provider Details

I. General information

NPI: 1881866804
Provider Name (Legal Business Name): ONCOLOGY RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E 19TH ST STE 102
TULSA OK
74104-5405
US

IV. Provider business mailing address

1705 E 19TH ST STE 102
TULSA OK
74104-5405
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-2908
  • Fax: 918-744-2947
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number25258
License Number StateOK

VIII. Authorized Official

Name: GARY METHENY
Title or Position: PHARMACY MANAGER
Credential:
Phone: 918-744-3185