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General NPI Number Information
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NPI Number | 1073484523
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Entity Type | Organization
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Legal Business Name | TELOS COMPOUNDING SOLUTIONS LLC
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 701 N MUSTANG RD STE C
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City | YUKON
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State | OK
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Zip | 73099-5671
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Country | US
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Telephone | 405-706-0079
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Fax |
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Provider Business Mailing Address
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Address Line | 701 N MUSTANG RD STE C
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City | YUKON
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State | OK
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Zip | 73099-5671
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Country | US
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Telephone | 405-706-0079
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JACOBY GRAY
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Credential | PHARMD
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Telephone | 405-706-0079
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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 |
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License Number State |
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