Healthcare Provider Details

I. General information

NPI: 1649324880
Provider Name (Legal Business Name): WESTVILLE PRESCRIPTION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S WILLIAMS
WESTVILLE OK
74965
US

IV. Provider business mailing address

PO BOX 405
WESTVILLE OK
74965-0405
US

V. Phone/Fax

Practice location:
  • Phone: 918-723-5466
  • Fax: 918-723-4465
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number46-4221
License Number StateOK

VIII. Authorized Official

Name: CLARK PHILLIPS
Title or Position: OWNER
Credential: DPH
Phone: 918-723-5466