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General NPI Number Information
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NPI Number | 1124286059
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Entity Type | Organization
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Legal Business Name | STATE OF OKLAHOMA
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 304 FAIRLANE AVE
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City | SULPHUR
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State | OK
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Zip | 73086-6861
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Country | US
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Telephone | 580-622-7500
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Fax | 580-622-7500
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Provider Business Mailing Address
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Address Line | 304 FAIRLANE AVE
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City | SULPHUR
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State | OK
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Zip | 73086-6861
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Country | US
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Telephone | 580-622-7500
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Fax | 580-622-7500
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Authorized Official
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Title or Position | IT STRATEGIST
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Name | KRIS VEITCH
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Credential |
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Telephone | 405-523-4091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 55-2200
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License Number State | OK
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