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General NPI Number Information
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NPI Number | 1205157724
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Entity Type | Organization
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Legal Business Name | CREST RX LLC
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 10601 S MAY AVE STE 11
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-2501
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Country | US
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Telephone | 405-378-7171
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Fax | 405-378-7173
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Provider Business Mailing Address
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Address Line | 10601 S MAY AVE STE 11
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-2501
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Country | US
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Telephone | 405-378-7171
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Fax | 405-378-7173
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Authorized Official
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Title or Position | MANAGER
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Name | SARA JUSTICE
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Credential |
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Telephone | 405-378-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 75537
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License Number State | OK
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