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General NPI Number Information
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NPI Number | 1013219096
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Entity Type | Organization
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Legal Business Name | OKULEYS PHARMACY & HOME MEDICAL OF WAUSEON INC
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Dates
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Enumeration Date | 11/24/2010
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 123 S FULTON ST
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City | WAUSEON
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State | OH
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Zip | 43567-1351
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Country | US
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Telephone | 419-335-6901
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Fax | 419-335-6901
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Provider Business Mailing Address
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Address Line | 123 S FULTON ST
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City | WAUSEON
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State | OH
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Zip | 43567-1351
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Country | US
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Telephone | 419-335-6901
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Fax | 419-335-6901
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | KIEU OKULEY
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Credential | RPH
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Telephone | 419-596-2003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RTP022089450
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License Number State | OH
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